Organization
MEDICAL DIAGNOSTIC SERVICES INC
Active
Parent organization
MEDICAL DIAGNOSTIC SERVICES INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDICAL DIAGNOSTIC SERVICES INC
Authorized official
MR. SHAMS SIDDIQUI (PRESIDENT)
(847) 626-0800
Entity
Organization
Contact information
Practice address
4479 PONTIAC LAKE RD, SUITE 1D, WATERFORD, MI 48328-2059
(248) 499-7618
(248) 499-7644
Mailing address
3701 JARVIS AVE, SKOKIE, IL 60076-4019
(847) 626-0800
(847) 626-0819
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F38158
BCBS PIN
MI
01
—
0H01066
BLUE CROSS BLUE SHIELD PIN
MI
01
—
P00658473
RAILROAD MEDICARE PIN
MI
Enumeration date
08/08/2008
Last updated
11/03/2014
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