Healthcare Provider Details

I. General information

NPI: 1649769746
Provider Name (Legal Business Name): ENVISION MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 NATIONAL PKWY STE 915-20
SCHAUMBURG IL
60173-5160
US

IV. Provider business mailing address

8930 WAUKEGAN RD STE 130
MORTON GROVE IL
60053-2132
US

V. Phone/Fax

Practice location:
  • Phone: 847-929-6200
  • Fax:
Mailing address:
  • Phone: 847-929-5482
  • Fax: 847-929-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: RICHARD KIM
Title or Position: MANAGER
Credential: MD
Phone: 847-929-5454