Healthcare Provider Details

I. General information

NPI: 1528218906
Provider Name (Legal Business Name): MRI OF CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 06/15/2009
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 StateIL

VIII. Authorized Official

Name: DR. MOHAMMED ALAWAD
Title or Position: MEMBER/OWNER
Credential: MD
Phone: 708-423-1819