Organization
MEDICAL DIAGNOSTIC SERVICES INC
Active
Parent organization
MEDICAL DIAGNOSTIC SERVICES INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDICAL DIAGNOSTIC SERVICES INC
Authorized official
MR. SHAMS SIDDIQUI (PRESIDENT)
(847) 626-0800
Entity
Organization
Contact information
Practice address
4479 PONTIAC LAKE RD, SUITE 1D, WATERFORD, MI 48328-2059
(248) 499-7618
(248) 499-7644
Mailing address
3701 JARVIS AVE, SKOKIE, IL 60076-4019
(847) 626-0800
(847) 626-0819
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F38711
BCBSM
MI
Enumeration date
07/29/2008
Last updated
11/03/2014
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