MEDICARE: CLOSER LOOK 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	2085R0202X	Diagnostic Radiology Physician	036101586	IL

General Provider Information

NPI Number	:	1518269935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOSER LOOK IMAGING LLC

Provider Business Mailing Address
First Line	:	7431 S EAST END AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3611
Country	:	US
Telephone Number	:	773-363-8080
Fax Number	:	773-891-4905

Provider Business Practice Location Address
First Line	:	7431 S EAST END AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3611
Country	:	US
Telephone Number	:	773-363-8080
Fax Number	:	773-891-4905

Authorized Official
Title or Position	:	CEO
Name	:	SAMEER SUHAIL
Credential	:	MD
Telephone Number	:	773-363-8080

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/07/2017

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