Healthcare Provider Details

I. General information

NPI: 1164614772
Provider Name (Legal Business Name): NAPERVILLE MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 BAY SCOTT CIR
NAPERVILLE IL
60540-1106
US

IV. Provider business mailing address

9000 WAUKEGAN RD SUITE 110
MORTON GROVE IL
60053-2127
US

V. Phone/Fax

Practice location:
  • Phone: 630-717-3700
  • Fax: 630-717-3701
Mailing address:
  • Phone: 847-213-2700
  • Fax: 847-213-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BRIAN R KINCAID
Title or Position: MANAGER
Credential:
Phone: 847-213-2700