Organization
NORTHEAST RADIOLOGY ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD DEBRUIN M.D. (PRESEIDENT)
(847) 535-6313
Entity
Organization
Contact information
Practice address
660 N WESTMORELAND RD, RADIOLOGY DEPARTMENT, LAKE FOREST, IL 60045-1659
(847) 535-6313
Mailing address
660 N WESTMORELAND RD, RADIOLOGY DEPARTMENT, LAKE FOREST, IL 60045-1659
(847) 535-6313
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4923631
BCBS ID
IL
01
—
CH1744
RAILROAD ID
—
Enumeration date
10/09/2006
Last updated
10/26/2007
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