Healthcare Provider Details

I. General information

NPI: 1215269196
Provider Name (Legal Business Name): ATHLETIC IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

IV. Provider business mailing address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-0299
  • Fax: 708-493-0594
Mailing address:
  • Phone: 708-493-0299
  • Fax: 708-493-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAJ KHANNA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 708-493-0299