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NPI Code Detail

MEDICARE: PREFERRED OPEN MRI, LTD.

MEDICARE: PREFERRED OPEN MRI, LTD.
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
12471B0102XBone Densitometry Radiologic Technologist
22471N0900XNuclear Medicine Technology Radiologic Technologist
32471C3401XComputed Tomography Radiologic Technologist
42471C3402XRadiography Radiologic Technologist
52085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11632652OTHERILBCBS OF ILL PROVIDER NUMB

General Provider Information

NPI Number : 1205888351
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREFERRED OPEN MRI, LTD.
Provider Business Mailing Address
First Line : 4200 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5010
Country : US
Telephone Number : 773-581-5600
Fax Number : 773-581-5608
Provider Business Practice Location Address
First Line : 4200 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5010
Country : US
Telephone Number : 773-581-5600
Fax Number : 773-581-5608
Authorized Official
Title or Position : PRESIDENT
Name : MR. NASER RUSTOM
Credential :
Telephone Number : 773-581-5600
Provider Enumeration Date : 05/17/2006
Last Update Date : 06/16/2022

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1982896023 — PREFERRED PAIN CARE SPECIALISTS
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Directions to “PREFERRED OPEN MRI, LTD. ” Practice Location

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