Healthcare Provider Details

I. General information

NPI: 1215368642
Provider Name (Legal Business Name): MOLECULAR IMAGING OF SUBURBAN CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E OGDEN AVE SUITE 100
HINSDALE IL
60521-2460
US

IV. Provider business mailing address

PO BOX 11276
BELFAST ME
04915-4003
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-6300
  • Fax:
Mailing address:
  • Phone: 630-325-6300
  • Fax: 630-214-2362

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: RAJEEV BATRA
Title or Position: OWNER
Credential:
Phone: 630-325-6300