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Organization
CANTON INTERVENTIONAL RADIOLOGIST GROUP PC
Active
Organization
CANTON INTERVENTIONAL RADIOLOGIST GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA ESPARZA (REVENUE CYCLE MANAGER)
(630) 725-2764
Entity
Organization
Contact information
Practice address
110 ALBANY TPKE STE 209, CANTON, CT 06019-2549
(860) 693-4060
(860) 693-4065
Mailing address
2001 BUTTERFIELD RD STE 300, DOWNERS GROVE, IL 60515-1069
(630) 725-2700
(833) 842-5469
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
NULL
202K00000X
Phlebology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
NULL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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