Organization
DIVISION MEDICAL & DIAGNOSTICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAGHU NAYAK (PRESIDENT)
(630) 986-1240
Entity
Organization
Contact information
Practice address
4913 W FULLERTON AVE, CHICAGO, IL 60639-2505
(773) 637-2000
(773) 367-2006
Mailing address
4913 W FULLERTON AVE, CHICAGO, IL 60639-2505
(773) 637-2000
(773) 367-2006
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1625675
BLUE SHIELD OF IL
IL
Enumeration date
09/14/2006
Last updated
08/22/2020
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