Healthcare Provider Details

I. General information

NPI: 1043472020
Provider Name (Legal Business Name): CORPORATE WOODS OPEN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CORPORATE WOODS PKWY
VERNON HILLS IL
60061-3111
US

IV. Provider business mailing address

555 CORPORATE WOODS PKWY
VERNON HILLS IL
60061-3111
US

V. Phone/Fax

Practice location:
  • Phone: 847-634-9400
  • Fax: 847-634-2900
Mailing address:
  • Phone: 847-634-9400
  • Fax: 847-634-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNE L. DEGENNARO
Title or Position: BUSINESS OFFICE ADMINISTRATOR
Credential:
Phone: 847-634-0400