Organization
PHC OF BUFFALO GROVE DIAGNOSTIC SERVICES
Active
Other names
Portrait Health Centers Diagnostic Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK A MAGGIORE PHD (DIRECTOR)
(847) 868-3435
Entity
Organization
Contact information
Practice address
150 W HALF DAY RD, SUITE 105, BUFFALO GROVE, IL 60089-6591
(847) 868-3435
(847) 859-5885
Mailing address
150 W HALF DAY RD, SUITE 105, BUFFALO GROVE, IL 60089-6591
(847) 868-3435
(847) 859-5885
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
—
—
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
08/30/2011
Last updated
08/31/2011
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