Organization
MOLECULAR IMAGING OF SUBURBAN CHICAGO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE TUCKER (DIRECTOR)
(630) 755-4327
Entity
Organization
Contact information
Practice address
230 EAST OGDEN AVENUE, SUITE 100, HINSDALE, IL 60521-3635
(630) 325-6300
(360) 214-2362
Mailing address
3 GRANT SQUARE, SUITE 322, HINSDALE, IL 60521-3635
(630) 325-6300
(630) 214-2362
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
0227301
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002232827
BLUE CROSS BLUE SHIELD
IL
01
—
21277392246
BEECH STREET
IL
01
—
7435790
AETNA
IL
01
—
ILA10
ONE CALL MEDICAL
IL
Enumeration date
05/27/2006
Last updated
11/08/2016
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