Healthcare Provider Details

I. General information

NPI: 1902896277
Provider Name (Legal Business Name): GLEN MEDICAL IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MILWAUKEE AVE SUITE 1016
BUFFALO GROVE IL
60089-2809
US

IV. Provider business mailing address

251 MILWAUKEE AVE SUITE 1016
BUFFFALO GROVE IL
60089-2826
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-9840
  • Fax: 847-215-9843
Mailing address:
  • Phone: 847-215-9840
  • Fax: 847-215-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEX AKSELRUD
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 847-215-9840