MEDICARE: ILLINOIS IMAGING, INC.

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	:	1881027860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS IMAGING, INC.

Provider Business Mailing Address
First Line	:	4044 N LINCOLN AVE
Second Line	:	SUITE 377
City	:	CHICAGO
State	:	IL
Zip	:	60618-3038
Country	:	US
Telephone Number	:	561-620-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4044 N LINCOLN AVE
Second Line	:	SUITE 377
City	:	CHICAGO
State	:	IL
Zip	:	60618-3038
Country	:	US
Telephone Number	:	561-620-3600
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PETER TURCO
Credential	:
Telephone Number	:	561-620-3600

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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