Organization
SOUTHLAKE MRI & DIAGNOSTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMAN CHOPRA (PRINCIPAL)
(219) 736-2700
Entity
Organization
Contact information
Practice address
108 E 90TH DR, MERRILLVILLE, IN 46410-7160
(219) 795-1801
(219) 795-1802
Mailing address
108 E 90TH DR, MERRILLVILLE, IN 46410-7160
(219) 795-1801
(219) 795-1802
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
XM017160
IN
261QR0200X
Radiology Clinic/Center
Primary
XF200740
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200500590
—
IN
Enumeration date
05/08/2006
Last updated
02/06/2013
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