MEDICARE: 4365 ARCHER MRI, 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	1959633	IL
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	1959633	IL

General Provider Information

NPI Number	:	1265765218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4365 ARCHER MRI, LLC

Provider Business Mailing Address
First Line	:	PO BOX 7389
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-7389
Country	:	US
Telephone Number	:	847-870-3600
Fax Number	:	847-370-3500

Provider Business Practice Location Address
First Line	:	4365 SOUTH ARCHER AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632
Country	:	US
Telephone Number	:	773-299-1071
Fax Number	:	773-299-1074

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MARVIN E. TAZELAAR
Credential	:
Telephone Number	:	773-299-1071

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

Similar Medicare Providers

1447195839 — DARLEAN IRENDA MARTIN PHARMD
Practice Location Address:

5435 S KEDZIE AVE
CHICAGO, IL
60632-2642

Practice Phone: 773-436-7396
Practice Fax:

1144163320 — LISSET MADERA-GONZALEZ
Practice Location Address:

4815 S KARLOV AVE
CHICAGO, IL
60632-4123

Practice Phone: 773-535-4875
Practice Fax:

1467131367 — DR. JEANJU LEE DMD
Practice Location Address:

3948 W 55TH ST
CHICAGO, IL
60632-3745

Practice Phone: 773-922-8000
Practice Fax:

1790573681 — SZU-HSIEN CHEN AGPCNP-BC
Practice Location Address:

4177 S ARCHER AVE
CHICAGO, IL
60632-1849

Practice Phone: 773-254-2222
Practice Fax:

1750789756 — NICOLE M. LIMON APN-CNP
Practice Location Address:

4327 S ARCHER AVE
CHICAGO, IL
60632

Practice Phone: 773-242-2370
Practice Fax:

1285631838 — DR. ANNA SAGAN-BLAUSIUS MD
Practice Location Address:

4321 S PULASKI ROAD
CHICAGO, IL
60632

Practice Phone: 773-585-2410
Practice Fax: 773-284-0913

1861490138 — MARIAELENA J. FAGADORE CNP
Practice Location Address:

4254 W 55TH ST
CHICAGO, IL
60632-4642

Practice Phone: 773-582-5200
Practice Fax: 773-582-2772

Directions to “4365 ARCHER MRI, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.