# ADVANCED MIDWEST INTERVENTIONAL RADIOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114438769
- **Authorized official:** MS. TARRA GRANT MA (PRACTICE MANAGER)
- **Authorized official phone:** (815) 900-9060

## Contact information

- **Practice address:** 1890 SILVER CROSS BLVD STE 450, NEW LENOX, IL 60451-9518
- **Practice address phone:** (815) 900-9060
- **Mailing address:** 3010 HIGHLAND PKWY STE 325, DOWNERS GROVE, IL 60515-5670
- **Mailing address phone:** (630) 581-6524

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/21/2017
- **Last updated:** 03/07/2025