Basic Information
| Provider Information | |||||||||
| NPI: | 1013965326 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED MIDWEST RADIOLOGY, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 HARGER RD STE 408 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305816504 | ||||||||
| FaxNumber: | 6306456407 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SILVER CROSS BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW LENOX | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157178478 | ||||||||
| FaxNumber: | 8157178794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | STONE | ||||||||
| AuthorizedOfficialFirstName: | SYLVIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6305816504 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 042000995 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.