MEDICARE: MOLECULAR IMAGING CHICAGO 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1669881686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLECULAR IMAGING CHICAGO LLC

Provider Business Mailing Address
First Line	:	3 GRANT SQUARE
Second Line	:	SUITE 322
City	:	HINSDALE
State	:	IL
Zip	:	60521
Country	:	US
Telephone Number	:	630-325-6300
Fax Number	:	630-214-2362

Provider Business Practice Location Address
First Line	:	4351 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1502
Country	:	US
Telephone Number	:	773-427-1222
Fax Number	:	773-427-1333

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. STEPHANIE TUCKER
Credential	:
Telephone Number	:	630-755-4327

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	11/08/2016

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