Healthcare Provider Details

I. General information

NPI: 1285699033
Provider Name (Legal Business Name): OPEN ADVANCED MRI OF ROUND LAKE, 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

720 E ROLLINS RD
ROUND LAKE BEACH IL
60073-1340
US

IV. Provider business mailing address

720 E ROLLINS RD
ROUND LAKE BEACH IL
60073-1340
US

V. Phone/Fax

Practice location:
  • Phone: 847-546-3600
  • Fax: 847-546-3633
Mailing address:
  • Phone: 847-546-3600
  • Fax: 847-546-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY PAT HOULIHAN
Title or Position: DIRECTOR
Credential:
Phone: 847-546-3600