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General NPI Number Information
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NPI Number | 1265626436
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Entity Type | Organization
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Legal Business Name | ADVANTAGE MRI-CAROL STREAM, LLC
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 640 E SAINT CHARLES RD SUITE 106
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City | CAROL STREAM
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State | IL
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Zip | 60188-3083
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Country | US
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Telephone | 630-462-0793
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Fax | 630-462-1376
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Provider Business Mailing Address
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Address Line | 2625 BUTTERFIELD RD STE 219S
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City | OAK BROOK
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State | IL
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Zip | 60523-1239
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Country | US
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Telephone | 630-755-4327
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Fax | 630-819-8153
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. STEPHANIE TUCKER
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Credential |
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Telephone | 630-755-4327
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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 |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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