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General NPI Number Information
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NPI Number | 1780826230
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Entity Type | Organization
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Legal Business Name | DIVISION MRI, INC.
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 2618 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-7107
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Country | US
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Telephone | 773-235-7455
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Fax | 773-235-7055
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Provider Business Mailing Address
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Address Line | PO BOX 220450
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City | CHICAGO
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State | IL
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Zip | 60622-0450
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Country | US
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Telephone | 773-235-7455
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Fax | 773-235-7055
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. AMER RUSTUM
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Credential | MD
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Telephone | 773-456-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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