Organization
METROPOLITAN DIAGNOSTIC IMAGING
Active
Other names
AMIC Merrionette Park
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE SMITH (ACCT RECEIVABLE)
(312) 807-3550
Entity
Organization
Contact information
Practice address
11600 S KEDZIE AVE, MERRIONETTE PARK, IL 60803-6302
(708) 377-3730
Mailing address
111 N WABASH AVE STE 620, CHICAGO, IL 60602-1914
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21621866
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/18/2008
Last updated
04/20/2008
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