Organization
BLOOMINGTON RADIOLOGY S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJAY MALPANI M.D. (PRESIDENT)
(309) 452-1788
Entity
Organization
Contact information
Practice address
2200 FORT JESSE RD, SUITE 280, NORMAL, IL 61761-6286
(309) 452-1788
(309) 862-1302
Mailing address
PO BOX 3668, BLOOMINGTON, IL 61702-3668
(309) 452-1788
(309) 862-1302
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
042001755
IL
2085N0700X
Neuroradiology Physician
042001755
IL
2085N0904X
Nuclear Radiology Physician
042001755
IL
2085R0202X
Diagnostic Radiology Physician
Primary
042001755
IL
2085R0204X
Vascular & Interventional Radiology Physician
042001755
IL
Other
Enumeration date
05/24/2006
Last updated
05/27/2021
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