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General NPI Number Information
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NPI Number | 1093770851
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Entity Type | Organization
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Legal Business Name | OPEN ADVANCED MRI OF CRYSTAL LAKE, LLC
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 820 E TERRA COTTA AVE SUITE 136
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3649
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Country | US
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Telephone | 815-444-1330
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Fax | 815-444-1279
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Provider Business Mailing Address
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Address Line | 820 E TERRA COTTA AVE SUITE 136
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3649
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Country | US
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Telephone | 815-444-1330
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Fax | 815-444-1279
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY PAT HOULIHAN
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Credential |
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Telephone | 815-444-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | IL
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