Organization
SONOGRAPHIC IMAGES, INC
Active
Other names
Sonographic Images, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WANDA LOGAN R.T. (CEO/OWNER)
(219) 836-4702
Entity
Organization
Contact information
Practice address
1021 W 5TH AVE, GARY, IN 46402-1703
(219) 836-4702
(708) 808-9755
Mailing address
1021 W 5TH AVE, 221, GARY, IN 46402-1703
(219) 836-4702
(708) 808-9755
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
156765
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001618757
BCBS
IL
05
—
100022050A
—
IN
Enumeration date
08/24/2006
Last updated
03/15/2012
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