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General NPI Number Information
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NPI Number | 1528845112
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Entity Type | Organization
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Legal Business Name | IMMACULATE MEDICAL IMAGING SC
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1450 BUSCH PKWY STE 107
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4541
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Country | US
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Telephone | 312-804-9878
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 BUSCH PKWY STE 107
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4541
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Country | US
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Telephone | 312-804-9878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | RACHIT MENDI
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Credential |
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Telephone | 312-804-9878
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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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