Provider Demographics
NPI:1104953017
Name:SOUMA DIAGNOSTICS, LTD
Entity type:Organization
Organization Name:SOUMA DIAGNOSTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACOG
Authorized Official - Phone:312-654-9100
Mailing Address - Street 1:PO BOX 11690
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-0690
Mailing Address - Country:US
Mailing Address - Phone:773-735-2110
Mailing Address - Fax:773-735-4238
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 1429
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-654-9100
Practice Address - Fax:312-654-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12926Medicare UPIN