Healthcare Provider Details

I. General information

NPI: 1508699604
Provider Name (Legal Business Name): A & A MOBILE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 JOHN HUMPHREY DR UNIT 3
ORLAND PARK IL
60462-2816
US

IV. Provider business mailing address

6130 BROOKWOOD DR
OAK FOREST IL
60452-2918
US

V. Phone/Fax

Practice location:
  • Phone: 708-971-3114
  • Fax:
Mailing address:
  • Phone: 708-971-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AYUOB SALEM
Title or Position: OWNER
Credential: RVT
Phone: 708-971-3114