Basic Information
| Provider Information | |||||||||
| NPI: | 1336320001 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY IMAGING VT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 COMMERCE DR | ||||||||
| Address2: | STE. 333 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309285224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 407 S 3RD ST | ||||||||
| Address2: | STE 240 | ||||||||
| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601342741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308972848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2007 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | AKBAR | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 6309784804 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VALLEY IMAGING VT, LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.