Organization
AMERICAN DIAGNOSTIC MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN TAZELAAR (DIRECTOR)
(630) 333-4674
Entity
Organization
Contact information
Practice address
360 W BUTTERFIELD RD, SUITE 130, ELMHURST, IL 60126-5068
(630) 333-4674
(630) 333-4567
Mailing address
360 W BUTTERFIELD RD, SUITE 130, ELMHURST, IL 60126-5068
(630) 333-4674
(630) 333-4567
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4853951
LISC
IL
Enumeration date
04/13/2012
Last updated
04/13/2012
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