Basic Information
| Provider Information | |||||||||
| NPI: | 1871935403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DINEEN | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RTT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAKOTA | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RTT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17750 KEDZIE AVE | ||||||||
| Address2: | |||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087999995 | ||||||||
| FaxNumber: | 7087998129 | ||||||||
| Practice Location | |||||||||
| Address1: | 17750 KEDZIE AVE | ||||||||
| Address2: | |||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087999995 | ||||||||
| FaxNumber: | 7087998129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2013 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | 500482171 | IL | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 2471R0002X | 500483727 | IL | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiation Therapy |
No ID Information.