Healthcare Provider Details
I. General information
NPI: 1417018318
Provider Name (Legal Business Name): MEDICAL IMAGING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7531 S STONY ISLAND AVE
CHICAGO IL
60649-3954
US
IV. Provider business mailing address
7531 S STONY ISLAND AVE
CHICAGO IL
60649-3954
US
V. Phone/Fax
- Phone: 773-947-7781
- Fax: 773-947-7792
- Phone: 773-947-7781
- Fax: 773-947-7792
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM1200X |
| Taxonomy | Magnetic Resonance Imaging (MRI) Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PETER
E
FRIEDELL
Title or Position: PRESIDENT
Credential: M. D.
Phone: 773-947-7781