Healthcare Provider Details

I. General information

NPI: 1578920401
Provider Name (Legal Business Name): HOPE WOMEN'S IMAGING AND MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 W DEVON AVE
CHICAGO IL
60659-1305
US

IV. Provider business mailing address

1378 MANASSAS CT
LONG GROVE IL
60047-5084
US

V. Phone/Fax

Practice location:
  • Phone: 847-927-9406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAYR NIAZI
Title or Position: CFO
Credential:
Phone: 847-927-9406