Provider Demographics
NPI:1043251838
Name:BLUE ISLAND RADIOLOGY CONSULTANTS
Entity type:Organization
Organization Name:BLUE ISLAND RADIOLOGY CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-388-0423
Mailing Address - Street 1:3300 127TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-3802
Mailing Address - Country:US
Mailing Address - Phone:708-388-0423
Mailing Address - Fax:708-388-1477
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615363OtherBLUE CROSS BLUE SHIELD
IL=========Medicaid
ILCI0789Medicare ID - Type UnspecifiedTRAVELERS MED GRP
IL=========Medicaid