Provider Demographics
NPI:1144285990
Name:OPEN ADVANCED MRI OF LINCOLN PARK, LLC
Entity type:Organization
Organization Name:OPEN ADVANCED MRI OF LINCOLN PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-929-9500
Mailing Address - Street 1:1355 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2134
Mailing Address - Country:US
Mailing Address - Phone:773-929-9500
Mailing Address - Fax:773-929-9544
Practice Address - Street 1:1355 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2134
Practice Address - Country:US
Practice Address - Phone:773-929-9500
Practice Address - Fax:773-929-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634366OtherBLUE SHIELD
ILDC7354OtherRAILROAD MEDICARE
IL209541Medicare ID - Type UnspecifiedGROUP NUMBER