Provider Demographics
NPI:1215368642
Name:MOLECULAR IMAGING OF SUBURBAN CHICAGO LLC
Entity Type:Organization
Organization Name:MOLECULAR IMAGING OF SUBURBAN CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:BATRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-325-6300
Mailing Address - Street 1:PO BOX 11276
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4003
Mailing Address - Country:US
Mailing Address - Phone:630-325-6300
Mailing Address - Fax:630-214-2362
Practice Address - Street 1:230 E OGDEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2460
Practice Address - Country:US
Practice Address - Phone:630-325-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212300Medicare UPIN