Healthcare Provider Details

I. General information

NPI: 1902861750
Provider Name (Legal Business Name): OPEN ADVANCED MRI OF PLAINFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 CATON FARM RD
PLAINFIELD IL
60586-8350
US

IV. Provider business mailing address

4714 CATON FARM RD
PLAINFIELD IL
60586-8350
US

V. Phone/Fax

Practice location:
  • Phone: 815-609-4988
  • Fax: 815-609-4989
Mailing address:
  • Phone: 815-609-4988
  • Fax: 815-609-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDB4311
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier09932181
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE SHIELD

VIII. Authorized Official

Name: JERRY ZEMELA
Title or Position: DIRECTOR
Credential:
Phone: 815-609-4988