Organization
BERWYN IMAGING LLC
Active
Other names
WESTERN OPEN MRI
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN TAZELAAR (DIRECTOR)
(630) 333-4674
Entity
Organization
Contact information
Practice address
6728 CERMAK RD, BERWYN, IL 60402-2217
(708) 788-8900
(708) 788-5110
Mailing address
6728 CERMAK RD, BERWYN, IL 60402-2217
(708) 788-8900
(708) 788-5110
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7087888900
TELEPHONE
IL
Enumeration date
05/25/2016
Last updated
10/19/2016
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