Provider Demographics
NPI:1932232873
Name:CARE DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:CARE DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOMAAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:AZEEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-338-3344
Mailing Address - Street 1:7459 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1735
Mailing Address - Country:US
Mailing Address - Phone:773-338-3344
Mailing Address - Fax:773-338-3355
Practice Address - Street 1:7459 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1735
Practice Address - Country:US
Practice Address - Phone:773-338-3344
Practice Address - Fax:773-338-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636375OtherBCBS
IL=========001Medicaid
IL213573Medicare PIN