Healthcare Provider Details

I. General information

NPI: 1144707399
Provider Name (Legal Business Name): NORTHWESTERN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 45TH ST
MUNSTER IN
46321-3986
US

IV. Provider business mailing address

PO BOX 3004
MUNSTER IN
46321-0004
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-0710
  • Fax:
Mailing address:
  • Phone: 219-703-2435
  • Fax: 219-934-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHAR KULLERSTRAND
Title or Position: REGIONAL DIRECTOR PATIENT FINANCIAL
Credential:
Phone: 219-934-8994