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General NPI Number Information
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NPI Number | 1821045659
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Entity Type | Organization
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Legal Business Name | EDGEBROOK RADIOLOGY MANAGEMENT
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 2410 S RIVER RD
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City | DES PLAINES
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State | IL
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Zip | 60018-3201
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Country | US
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Telephone | 773-774-6440
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Fax | 773-774-4372
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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 NELLAMATHATIL
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Credential |
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Telephone | 773-774-6440
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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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