Healthcare Provider Details

I. General information

NPI: 1366490740
Provider Name (Legal Business Name): MORTON GROVE MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 WAUKEGAN RD SUITE 110
MORTON GROVE IL
60053-2111
US

IV. Provider business mailing address

9000 WAUKEGAN RD SUITE 110
MORTON GROVE IL
60053-2111
US

V. Phone/Fax

Practice location:
  • Phone: 847-213-2700
  • Fax: 847-213-2700
Mailing address:
  • Phone: 847-213-2700
  • Fax: 847-213-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GOLDIN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 847-213-2700