Organization
ARCHER KEDZIE IMAGING LLC
Active
Other names
Archer Kedzie Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN E. TAZELAAR (MANAGER)
(773) 299-1070
Entity
Organization
Contact information
Practice address
4365 S ARCHER AVE, CHICAGO, IL 60632-2826
(773) 299-1070
(773) 299-1075
Mailing address
4365 S ARCHER AVE, CHICAGO, IL 60632-2826
(773) 299-1070
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
1964943
IL
261QR0200X
Radiology Clinic/Center
1964943
IL
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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