MEDICARE: LOGAN SQUARE MRI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1730391434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN SQUARE MRI

Provider Business Mailing Address
First Line	:	2008 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3767
Country	:	US
Telephone Number	:	773-227-3950
Fax Number	:	773-252-3091

Provider Business Practice Location Address
First Line	:	2008 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3767
Country	:	US
Telephone Number	:	773-227-3950
Fax Number	:	773-252-3091

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS TERRI NASSAR
Credential	:
Telephone Number	:	773-227-3950

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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