Organization
TRI CITY RADIOLOGY S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH M PERSAK M.D. (DIRECTOR)
(630) 208-4412
Entity
Organization
Contact information
Practice address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 208-3000
Mailing address
825 W STATE ST, SUITE 103E, GENEVA, IL 60134-2080
(630) 208-4412
(630) 208-0201
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04515240
BLUE CROSS PROVIDER NUMBE
IL
Enumeration date
09/13/2006
Last updated
09/11/2025
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