Healthcare Provider Details

I. General information

NPI: 1891019097
Provider Name (Legal Business Name): MIDWEST CENTER FOR ADVANCED IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 MONTGOMERY RD.
NAPERVILLE IL
60564-9542
US

IV. Provider business mailing address

4355 MONTGOMERY RD
NAPERVILLE IL
60564-9542
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-8300
  • Fax: 630-236-9860
Mailing address:
  • Phone: 630-236-8300
  • Fax: 630-236-9860

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: NADINE ANN ROY
Title or Position: CFO
Credential:
Phone: 630-236-8300