| NPI | 1134605165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARINA ROSSOMAKHA Credentialing Specialist 847-929-5482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2018-10-31 |