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Organization
ARCHER KEDZIE IMAGING LLC
Active
Organization
ARCHER KEDZIE IMAGING LLC
Active
Other names
Archer Kedzie Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN E. TAZELAAR (MANAGER)
(773) 299-1070
Entity
Organization
Contact information
Practice address
4365 S ARCHER AVE, CHICAGO, IL 60632-2826
(773) 299-1070
(773) 299-1075
Mailing address
4365 S ARCHER AVE, CHICAGO, IL 60632-2826
(773) 299-1070
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
1964943
IL
261QR0200X
Radiology Clinic/Center
1964943
IL
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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