Basic Information
| Provider Information | |||||||||
| NPI: | 1487680765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN ILLINOIS IMAGING SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 665 | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601150665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157588671 | ||||||||
| FaxNumber: | 8157581731 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601153742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157588671 | ||||||||
| FaxNumber: | 8157581731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN-BOARD OF DIRECTORS | ||||||||
| AuthorizedOfficialTelephone: | 8157588671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine |
No ID Information.