Provider Demographics
NPI:1225093081
Name:OPEN ADVANCED MRI OF DEER PARK, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF DEER PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:CURRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-550-6740
Mailing Address - Street 1:20530 N RAND RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7233
Mailing Address - Country:US
Mailing Address - Phone:847-550-6740
Mailing Address - Fax:847-550-9997
Practice Address - Street 1:20530 N RAND RD
Practice Address - Street 2:SUITE 350
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-7233
Practice Address - Country:US
Practice Address - Phone:847-550-6740
Practice Address - Fax:847-550-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2015-11-24
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
IL04932417OtherBLUE SHIELD
ILDC9431OtherRAILROAD MEDICARE
IL210909Medicare ID - Type UnspecifiedGROUP NUMBER