Provider Demographics
NPI:1285875690
Name:SPECTRUM DIAGNOSTIC IMAGING INC
Entity type:Organization
Organization Name:SPECTRUM DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-362-6064
Mailing Address - Street 1:3140 FINLEY RD STE B
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1154
Mailing Address - Country:US
Mailing Address - Phone:630-395-9233
Mailing Address - Fax:630-395-9428
Practice Address - Street 1:3140 FINLEY RD STE B
Practice Address - Street 2:SUITE B
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1154
Practice Address - Country:US
Practice Address - Phone:630-395-9233
Practice Address - Fax:630-395-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile