Healthcare Provider Details

I. General information

NPI: 1922492628
Provider Name (Legal Business Name): ADVANCED IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 111TH ST
CHICAGO IL
60628-4200
US

IV. Provider business mailing address

900 OAKMONT LN 400
WESTMONT IL
60559-5530
US

V. Phone/Fax

Practice location:
  • Phone: 630-929-3034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUDHEER PARUCHURI
Title or Position: OWNER
Credential: MD
Phone: 312-622-7622