Provider Demographics
NPI:1033535521
Name:ATHLETE IMAGING LLC
Entity Type:Organization
Organization Name:ATHLETE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIVAMURTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-571-6063
Mailing Address - Street 1:2615 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8785
Practice Address - Country:US
Practice Address - Phone:847-571-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology