MEDICARE: MIDWEST RADIOLOGY ILLINOIS, 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
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1770795718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST RADIOLOGY ILLINOIS, LTD

Provider Business Mailing Address
First Line	:	4955 N MILWAUKEE AVE
Second Line	:	SUITE 8
City	:	CHICAGO
State	:	IL
Zip	:	60630-2286
Country	:	US
Telephone Number	:	773-736-6283
Fax Number	:	773-736-1403

Provider Business Practice Location Address
First Line	:	4955 N MILWAUKEE AVE
Second Line	:	SUITE 8
City	:	CHICAGO
State	:	IL
Zip	:	60630-2286
Country	:	US
Telephone Number	:	773-736-6283
Fax Number	:	773-736-1403

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PIERRE ELIE CHATELAIN
Credential	:
Telephone Number	:	630-209-8405

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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