# 4365 ARCHER MRI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Archer Open MRI
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265765218
- **Authorized official:** DR. MARVIN E. TAZELAAR (MANAGER)
- **Authorized official phone:** (773) 299-1071

## Contact information

- **Practice address:** 4365 SOUTH ARCHER AVENUE, CHICAGO, IL 60632
- **Practice address phone:** (773) 299-1071
- **Practice address fax:** (773) 299-1074
- **Mailing address:** PO BOX 7389, PROSPECT HEIGHTS, IL 60070-7389
- **Mailing address phone:** (847) 870-3600
- **Mailing address fax:** (847) 370-3500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | 1959633 | IL | Yes |
| 261QR0200X | Radiology Clinic/Center | 1959633 | IL | — |

## Other

- **Enumeration date:** 09/09/2009
- **Last updated:** 09/09/2009