Healthcare Provider Details

I. General information

NPI: 1578074274
Provider Name (Legal Business Name): MRAD IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9680 GOLF RD
DES PLAINES IL
60016-1522
US

IV. Provider business mailing address

9680 GOLF RD
DES PLAINES IL
60016-1522
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-5366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN SALDANHA
Title or Position: DIRECTOR
Credential:
Phone: 847-296-5366