MEDICARE: OAK MILL IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1634910	OTHER	IL	BLUE CROSS BLUE SHIELD #

General Provider Information

NPI Number	:	1134184906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK MILL IMAGING, LLC

Provider Business Mailing Address
First Line	:	7900 N MILWAUKEE AVE
Second Line	:	STE. 16A
City	:	NILES
State	:	IL
Zip	:	60714-3159
Country	:	US
Telephone Number	:	847-626-0124
Fax Number	:	847-626-0127

Provider Business Practice Location Address
First Line	:	7900 N MILWAUKEE AVE
Second Line	:	STE. 16A
City	:	NILES
State	:	IL
Zip	:	60714-3159
Country	:	US
Telephone Number	:	847-626-0124
Fax Number	:	847-626-0127

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GORDON GLUCKMAN
Credential	:	M.D.
Telephone Number	:	847-626-0124

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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Directions to “OAK MILL IMAGING, LLC ” Practice Location

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