Organization
MERIDIAN REGIONAL IMAGING,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY ANDREW RANAHAN (CEO)
(847) 816-3007
Entity
Organization
Contact information
Practice address
1035 CAMPUS DR, MUNDELEIN, IL 60060-3834
(847) 816-3007
Mailing address
1035 CAMPUS DR, MUNDELEIN, IL 60060-3834
(847) 816-3007
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4932299
BLUE SHIELD
IL
Enumeration date
05/25/2006
Last updated
10/02/2007
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