Organization
4365 ARCHER MRI, LLC
Active
Other names
Archer Open MRI
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN E. TAZELAAR (MANAGER)
(773) 299-1071
Entity
Organization
Contact information
Practice address
4365 SOUTH ARCHER AVENUE, CHICAGO, IL 60632
(773) 299-1071
(773) 299-1074
Mailing address
PO BOX 7389, PROSPECT HEIGHTS, IL 60070-7389
(847) 870-3600
(847) 370-3500
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
1959633
IL
261QR0200X
Radiology Clinic/Center
1959633
IL
Other
Enumeration date
09/09/2009
Last updated
09/09/2009
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