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
SHAMS U 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
207RC0000X
Cardiovascular Disease Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F38038
BCBS PIN
MI
01
—
0H01066
BLUE CROSS BLUE SHIELD PIN
MI
05
—
1912169186
—
MI
Enumeration date
06/30/2008
Last updated
01/25/2015
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