Basic Information
| Provider Information | |||||||||
| NPI: | 1902857881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RANDALLWOOD RADIOLOGY ASSOCIATES, S. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1121 LAKE COOK ROAD | ||||||||
| Address2: | SUITE M | ||||||||
| City: | DEERFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600155234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479454550 | ||||||||
| FaxNumber: | 8479488103 | ||||||||
| Practice Location | |||||||||
| Address1: | 1416C SOUTH RANDALL ROAD | ||||||||
| Address2: | RANDALL SQUARE SHOPPING CENTER | ||||||||
| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302089325 | ||||||||
| FaxNumber: | 6302089326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6302089325 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 04532176 | 01 | IL | BCBS IL | OTHER |