| Professional Diagnostic Service, S.c. | |
|
821 W Van Buren St Chicago IL 60607-3517 | |
| (312) 491-0404 | |
| (312) 491-0505 |
| Full Name | Professional Diagnostic Service, S.c. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 821 W Van Buren St, Chicago, Illinois |
| Authorized Official Name and Position | Kenneth Davis (PRESIDENT) |
| Authorized Official Contact | 3124910404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Diagnostic Service, S.c. 821 W Van Buren St Chicago IL 60607-3517 Ph: (312) 491-0404 | Professional Diagnostic Service, S.c. 821 W Van Buren St Chicago IL 60607-3517 Ph: (312) 491-0404 |
| NPI Number | 1003063421 |
|---|---|
| Provider Enumeration Date | 08/27/2008 |
| Last Update Date | 08/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003063421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A-3920-0003-A (Illinois) | Primary |
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