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General NPI Number Information
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NPI Number | 1609823442
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Entity Type | Organization
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Legal Business Name | HUNTLEY RADIOLOGY, LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 12396 PRINCETON DR
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City | HUNTLEY
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State | IL
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Zip | 60142-7655
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Country | US
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Telephone | 847-659-1377
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Fax | 847-659-1380
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Provider Business Mailing Address
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Address Line | PO BOX 7389
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City | PROSPECT HEIGHTS
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State | IL
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Zip | 60070-7389
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Country | US
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Telephone | 847-870-3600
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Fax | 847-870-3500
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. GEORGE NELLAMATTATHIL
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Credential |
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Telephone | 847-659-1377
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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 |
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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 | IL
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