Organization
PROVENA IMAGING SERVICES INC
Active
Other names
Provena Health Center for Diagnostic Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD MOLARE (PRESIDENT)
(815) 806-2309
Entity
Organization
Contact information
Practice address
100 PROVENA WAY, SUITE 104, BOURBONNAIS, IL 60914
(815) 929-5800
(815) 929-5801
Mailing address
5775 WAYZATA BLVD, SUITE 400, ST LOUIS PARK, MN 55416
(952) 542-8553
(952) 513-6880
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
08/30/2006
Last updated
08/22/2020
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