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Organization
PHC OF BUFFALO GROVE DIAGNOSTIC SERVICES
Active
Organization
PHC OF BUFFALO GROVE DIAGNOSTIC SERVICES
Active
Other names
Portrait Health Centers Diagnostic Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK A MAGGIORE PHD (DIRECTOR)
(847) 868-3435
Entity
Organization
Contact information
Practice address
150 W HALF DAY RD, SUITE 105, BUFFALO GROVE, IL 60089-6591
(847) 868-3435
(847) 859-5885
Mailing address
150 W HALF DAY RD, SUITE 105, BUFFALO GROVE, IL 60089-6591
(847) 868-3435
(847) 859-5885
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
—
—
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
08/30/2011
Last updated
08/31/2011
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