Provider Demographics
NPI:1184703209
Name:WESTERN SPRINGS DIAGNOSTIC OSTEOPOROSIS CENTER, LLC
Entity type:Organization
Organization Name:WESTERN SPRINGS DIAGNOSTIC OSTEOPOROSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRUMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-246-7222
Mailing Address - Street 1:5600 WOLF RD STE 160
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2254
Mailing Address - Country:US
Mailing Address - Phone:708-783-1198
Mailing Address - Fax:708-246-7286
Practice Address - Street 1:5600 WOLF RD STE 160
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2254
Practice Address - Country:US
Practice Address - Phone:708-783-1198
Practice Address - Fax:708-246-7286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9255759261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200634Medicare PIN