Provider Demographics
NPI:1992962682
Name:MEDICAL DIAGNOSTIC SERVICES INC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAMS
Authorized Official - Middle Name:U
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-626-0800
Mailing Address - Street 1:3701 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4019
Mailing Address - Country:US
Mailing Address - Phone:847-626-0800
Mailing Address - Fax:847-626-0819
Practice Address - Street 1:3701 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-4019
Practice Address - Country:US
Practice Address - Phone:847-626-0800
Practice Address - Fax:847-626-0819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL DIAGNOSTIC SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-20
Last Update Date:2015-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215743Medicare PIN