Provider Demographics
NPI:1023764255
Name:INNOVATIVE IMAGING SOLUTIONS
Entity type:Organization
Organization Name:INNOVATIVE IMAGING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-607-9311
Mailing Address - Street 1:PO BOX 7115
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-7115
Mailing Address - Country:US
Mailing Address - Phone:630-607-9311
Mailing Address - Fax:708-350-9709
Practice Address - Street 1:148 GROVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5856
Practice Address - Country:US
Practice Address - Phone:630-607-9311
Practice Address - Fax:708-350-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography