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General NPI Number Information
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NPI Number | 1467409540
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Entity Type | Organization
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Legal Business Name | MOLECULAR IMAGING OF SUBURBAN CHICAGO, LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 230 EAST OGDEN AVENUE SUITE 100
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City | HINSDALE
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State | IL
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Zip | 60521-3635
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Country | US
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Telephone | 630-325-6300
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Fax | 360-214-2362
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Provider Business Mailing Address
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Address Line | 3 GRANT SQUARE SUITE 322
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City | HINSDALE
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State | IL
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Zip | 60521-3635
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Country | US
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Telephone | 630-325-6300
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Fax | 630-214-2362
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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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 0227301
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License Number State | IL
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