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General NPI Number Information
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NPI Number | 1134178148
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Entity Type | Organization
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Legal Business Name | SOUTHLAKE MRI & DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 108 E 90TH DR
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7160
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Country | US
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Telephone | 219-795-1801
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Fax | 219-795-1802
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Provider Business Mailing Address
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Address Line | 108 E 90TH DR
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7160
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Country | US
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Telephone | 219-795-1801
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Fax | 219-795-1802
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Authorized Official
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Title or Position | PRINCIPAL
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Name | RAMAN CHOPRA
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Credential |
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Telephone | 219-736-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | XM017160
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | XF200740
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License Number State | IN
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