Healthcare Provider Details

I. General information

NPI: 1205888351
Provider Name (Legal Business Name): PREFERRED OPEN MRI, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W 63RD ST
CHICAGO IL
60629-5010
US

IV. Provider business mailing address

4200 W 63RD ST
CHICAGO IL
60629-5010
US

V. Phone/Fax

Practice location:
  • Phone: 773-581-5600
  • Fax: 773-581-5608
Mailing address:
  • Phone: 773-581-5600
  • Fax: 773-581-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NASER RUSTOM
Title or Position: PRESIDENT
Credential:
Phone: 773-581-5600