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General NPI Number Information
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NPI Number | 1477886034
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Entity Type | Organization
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Legal Business Name | FULLERTON MRI LLC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 3405 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2415
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Country | US
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Telephone | 773-697-8125
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Fax | 773-697-8542
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Provider Business Mailing Address
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Address Line | 3405 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2415
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Country | US
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Telephone | 773-697-8125
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Fax | 773-697-8542
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Authorized Official
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Title or Position | PRESIDENT
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Name | RENLIN XIA
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Credential | M.D.
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Telephone | 773-697-8125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State | IL
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