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Organization
CENTRAL ILLINOIS DIAGNOSTIC IMAGING CENTER, LLC
Active
Organization
CENTRAL ILLINOIS DIAGNOSTIC IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN SEIBERT D.M.D., MS (PRESIDENT)
(217) 398-4594
Entity
Organization
Contact information
Practice address
3002 CROSSING CT, CHAMPAIGN, IL 61822-6135
(217) 398-4594
Mailing address
1804 BENTBROOK DR, CHAMPAIGN, IL 61822-9218
(217) 352-2711
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
021001261
IL
261QR0200X
Radiology Clinic/Center
Primary
021001261
IL
Other
Enumeration date
08/27/2009
Last updated
10/25/2016
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