Basic Information
| Provider Information | |||||||||
| NPI: | 1386837987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRUNDY RADIOLOGISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 HARGER RD STE 408 | ||||||||
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| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305816504 | ||||||||
| FaxNumber: | 8159416940 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604501463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305816504 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | JACHEC | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8159411790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 036092647 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.