# ARCHER KEDZIE IMAGING LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Archer Kedzie Imaging
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881827251
- **Authorized official:** DR. MARVIN E. TAZELAAR (MANAGER)
- **Authorized official phone:** (773) 299-1070

## Contact information

- **Practice address:** 4365 S ARCHER AVE, CHICAGO, IL 60632-2826
- **Practice address phone:** (773) 299-1070
- **Practice address fax:** (773) 299-1075
- **Mailing address:** 4365 S ARCHER AVE, CHICAGO, IL 60632-2826
- **Mailing address phone:** (773) 299-1070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | 1964943 | IL | Yes |
| 261QR0200X | Radiology Clinic/Center | 1964943 | IL | — |

## Other

- **Enumeration date:** 09/01/2009
- **Last updated:** 09/01/2009