Healthcare Provider Details

I. General information

NPI: 1700820560
Provider Name (Legal Business Name): SALT CREEK MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 OAKMONT LN STE. 1200
WESTMONT IL
60559-5511
US

IV. Provider business mailing address

777 OAKMONT LN STE. 1200
WESTMONT IL
60559-5511
US

V. Phone/Fax

Practice location:
  • Phone: 630-413-4490
  • Fax:
Mailing address:
  • Phone: 630-413-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAHESH PURI
Title or Position: DIRECTOR
Credential:
Phone: 630-413-4490