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Organization
ADVANCED MIDWEST INTERVENTIONAL RADIOLOGY, LLC
Active
Organization
ADVANCED MIDWEST INTERVENTIONAL RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TARRA GRANT MA (PRACTICE MANAGER)
(815) 900-9060
Entity
Organization
Contact information
Practice address
1890 SILVER CROSS BLVD STE 450, NEW LENOX, IL 60451-9518
(815) 900-9060
Mailing address
3010 HIGHLAND PKWY STE 325, DOWNERS GROVE, IL 60515-5670
(630) 581-6524
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
NULL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Enumeration date
10/21/2017
Last updated
03/07/2025
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