Healthcare Provider Details

I. General information

NPI: 1790944197
Provider Name (Legal Business Name): LAKE ZURICH OPEN MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W HIGHWAY 22
LAKE ZURICH IL
60047-2552
US

IV. Provider business mailing address

1616 EAST ROOSEVELT ROAD SUITE 5
WHEATON IL
60187
US

V. Phone/Fax

Practice location:
  • Phone: 847-726-0674
  • Fax: 847-726-0675
Mailing address:
  • Phone: 877-444-4540
  • Fax: 847-550-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWIN C SAGE
Title or Position: MEMBER MANAGER
Credential:
Phone: 877-444-4540