Organization
METROPOLITAN DIAGNOSTIC IMAGING
Active
Other names
AMIC Hyde Park Open MRI
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL LELAND DO (PRESIDENT/MEDICAL DIRECTOR)
(312) 807-3555
Entity
Organization
Contact information
Practice address
1332 E 47TH ST, CHICAGO, IL 60653-4508
(773) 624-5400
(773) 624-5408
Mailing address
111 N WABASH AVE, SUITE 620, CHICAGO, IL 60602-1903
(312) 807-3555
(312) 807-3922
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 SHEILD
IL
Enumeration date
08/11/2006
Last updated
08/22/2020
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