Medulla Diagnostic Services PLLC

Primary specialty

Radiology ChiropractorTaxonomy code 111NR0200X

Legal business name

MEDULLA DIAGNOSTIC SERVICES PLLC

Practice address

2625 Butterfield Rd Ste 301N
Oak Brook, IL 60523-1266

Phone

(630) 468-1824

NPI assigned

Dec 19, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stuart Bernsen

Title

Ceo

Phone

(847) 912-2411

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702944000000",
    "number": "1811765779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 BUTTERFIELD RD STE 301N",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231266",
            "telephone_number": "630-468-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 BUTTERFIELD RD STE 301N",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231266",
            "telephone_number": "630-468-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDULLA DIAGNOSTIC SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-19",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "BERNSEN",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-912-2411"
    },
    "taxonomies": [
        {
            "code": "111NR0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.