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NPI Profile for PROVENA IMAGING SERVICES INC in BOURBONNAIS, IL.
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Diagnostic Radiology |
2085R0202X | 30 | Physician/Diagnostic Radiology |
| NPI # | 1720197601 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 08/30/2006 | |
| Last updated | 08/22/2020 - About 6 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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PROVENA IMAGING SERVICES INC
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PROVENA IMAGING SERVICES INC