Basic Information
| Provider Information | |||||||||
| NPI: | 1376079236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL RADIOLOGY CONSULTANTS OF ILLINOIS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2540 GREEN FOREST LN | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335585388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139205200 | ||||||||
| FaxNumber: | 8139205228 | ||||||||
| Practice Location | |||||||||
| Address1: | 2875 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606233501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139205200 | ||||||||
| FaxNumber: | 8139205228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | OKOH | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8139205200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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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.