Healthcare Provider Details

I. General information

NPI: 1972541225
Provider Name (Legal Business Name): STANDUP MRI OF DEERFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 LAKE COOK RD
DEERFIELD IL
60015-5202
US

IV. Provider business mailing address

457 LAKE COOK RD
DEERFIELD IL
60015-5202
US

V. Phone/Fax

Practice location:
  • Phone: 847-291-3921
  • Fax: 847-291-9362
Mailing address:
  • Phone: 847-291-3921
  • Fax: 847-291-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number99999999
License Number StateIL

VIII. Authorized Official

Name: FAITH THOMPSON
Title or Position: BILLING/CREDENTIALLING
Credential:
Phone: 225-612-8806