Organization
CHICAGO RIDGE RADIOLOGY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDUL AMINE M.D. (VICE PRESIDENT)
(708) 430-3350
Entity
Organization
Contact information
Practice address
9830 RIDGELAND AVE, STE #4, CHICAGO RIDGE, IL 60415-2667
(708) 423-1819
(708) 423-4788
Mailing address
2448 S 102ND ST, STE 125, WEST ALLIS, WI 53227-2466
(414) 328-3800
(414) 328-3818
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36043669
—
IL
Enumeration date
07/24/2006
Last updated
04/01/2010
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