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Organization

LIBERTY DIAGNOSTIC SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY LEE COLLETT RDMS (CEO)
(815) 338-2411
Entity
Organization

Contact information

Practice address
518 S HIGHWAY 31, MCHENRY, IL 60050-7464
(815) 338-2411
Mailing address
518 S HIGHWAY 31, MCHENRY, IL 60050-7464
(815) 338-2411

Taxonomy

Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6019701
IL
Enumeration date
01/09/2012
Last updated
01/09/2012
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