Healthcare Provider Details

I. General information

NPI: 1902956923
Provider Name (Legal Business Name): CHICAGO NORTHSIDE HOSPITAL MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST SUITE 102
CHICAGO IL
60642-2605
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-2818
  • Fax: 773-525-8589
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. KARA RICHARDSON
Title or Position: VP MANAGED HEALTH
Credential:
Phone: 980-416-4068