Basic Information
| Provider Information | |||||||||
| NPI: | 1841423696 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED MEDICAL IMAGING OF JOLIET, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 S 70TH ST | ||||||||
| Address2: | SUITE N500 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532143151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144554780 | ||||||||
| FaxNumber: | 4144752936 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 N MADISON AVE | ||||||||
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| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156094988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 08/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | CARDUCCI | ||||||||
| AuthorizedOfficialFirstName: | DOMINICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 7038931919 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MIDI II, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.