Healthcare Provider Details

I. General information

NPI: 1093062051
Provider Name (Legal Business Name): MRI OF CHICAGO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 N CICERO AVE
CHICAGO IL
60641-3623
US

IV. Provider business mailing address

3855 N CICERO AVE
CHICAGO IL
60641-3623
US

V. Phone/Fax

Practice location:
  • Phone: 773-777-2888
  • Fax: 773-777-0072
Mailing address:
  • Phone: 773-777-2888
  • Fax: 773-777-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AATIF U RAHMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-203-2753