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General NPI Number Information
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NPI Number | 1922456474
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Entity Type | Organization
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Legal Business Name | BERWYN IMAGING LLC
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 6728 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2217
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Country | US
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Telephone | 708-788-8900
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Fax | 708-788-5110
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Provider Business Mailing Address
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Address Line | 6728 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2217
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Country | US
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Telephone | 708-788-8900
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Fax | 708-788-5110
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARVIN TAZELAAR
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Credential |
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Telephone | 630-333-4674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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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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