# NORTHWEST SUBURBAN IMAGING ASSOCIATES, S.C.

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

## Provider details

- **NPI number:** 1356310163
- **Authorized official:** AJAY MEHTA M.D. (PRESIDENT)
- **Authorized official phone:** (847) 742-9800

## Contact information

- **Practice address:** 1425 N RANDALL RD, ELGIN, IL 60123-2300
- **Practice address phone:** (847) 742-9800
- **Mailing address:** 34659 EAGLE WAY, CHICAGO, IL 60678-1346
- **Mailing address phone:** (630) 874-2542
- **Mailing address fax:** (630) 874-2642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207U00000X | Nuclear Medicine Physician | 036062431 | IL | — |
| 2085N0904X | Nuclear Radiology Physician | 036062431 | IL | — |
| 2085R0202X | Diagnostic Radiology Physician | 036062431 | IL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | 036062431 | IL | Yes |

## Other

- **Enumeration date:** 03/15/2006
- **Last updated:** 06/01/2012