Healthcare Provider Details

I. General information

NPI: 1083828768
Provider Name (Legal Business Name): AR RADIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E WALTON ST SUITE 106
CHICAGO IL
60611-1448
US

IV. Provider business mailing address

100 E WALTON ST SUITE 106
CHICAGO IL
60611-1448
US

V. Phone/Fax

Practice location:
  • Phone: 312-587-1111
  • Fax: 312-587-1110
Mailing address:
  • Phone: 312-587-1111
  • Fax: 312-587-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ANDREW ROSENSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 312-587-1111