Provider Demographics
NPI:1871527713
Name:BRIGHT LIGHT MEDICAL IMAGING, SC
Entity type:Organization
Organization Name:BRIGHT LIGHT MEDICAL IMAGING, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RESHAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-439-2315
Mailing Address - Street 1:31 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1405
Mailing Address - Country:US
Mailing Address - Phone:847-439-2315
Mailing Address - Fax:847-439-3935
Practice Address - Street 1:31 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1405
Practice Address - Country:US
Practice Address - Phone:847-439-2315
Practice Address - Fax:847-439-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212909Medicare UPIN
IL206358Medicare ID - Type UnspecifiedGROUP