Organization
OPEN ADVANCED MRI OF LINCOLN PARK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY ROBINSON (DIRECTOR)
(773) 929-9500
Entity
Organization
Contact information
Practice address
1355 W FULLERTON AVE, CHICAGO, IL 60614-2134
(773) 929-9500
(773) 929-9544
Mailing address
1355 W FULLERTON AVE, CHICAGO, IL 60614-2134
(773) 929-9500
(773) 929-9544
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634366
BLUE SHIELD
IL
01
—
DC7354
RAILROAD MEDICARE
IL
Enumeration date
04/17/2006
Last updated
08/22/2020
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