Healthcare Provider Details

I. General information

NPI: 1417059403
Provider Name (Legal Business Name): WEST REGIONAL MRI LTD PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 W 22ND ST STE 105
OAK BROOK IL
60523-4647
US

IV. Provider business mailing address

2425 W 22ND ST STE 105
OAK BROOK IL
60523-4647
US

V. Phone/Fax

Practice location:
  • Phone: 630-990-4674
  • Fax: 630-572-1455
Mailing address:
  • Phone: 630-990-4674
  • Fax: 630-572-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: GAELANE ROSINSKI
Title or Position: CONTRACTING CREDENTIALING SPECIALIS
Credential:
Phone: 847-658-0996