Healthcare Provider Details

I. General information

NPI: 1003226960
Provider Name (Legal Business Name): AMR ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 07/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S MAIN ST STE 206
LOMBARD IL
60148-5365
US

IV. Provider business mailing address

2200 S MAIN ST STE 206
LOMBARD IL
60148-5365
US

V. Phone/Fax

Practice location:
  • Phone: 630-519-3485
  • Fax: 630-230-8386
Mailing address:
  • Phone: 630-519-3485
  • Fax: 630-230-8386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036099445
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number036-099445
License Number StateIL

VIII. Authorized Official

Name: DR. AMJAD ALI SAFVI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 630-650-0580