Provider Demographics
NPI:1265497028
Name:OPEN ADVANCED MRI OF SCHAUMBURG, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF SCHAUMBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-397-2300
Mailing Address - Street 1:1834 WALDEN OFFICE SQ
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4292
Mailing Address - Country:US
Mailing Address - Phone:847-397-2300
Mailing Address - Fax:847-397-6140
Practice Address - Street 1:1834 WALDEN OFFICE SQ
Practice Address - Street 2:SUITE 125
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4292
Practice Address - Country:US
Practice Address - Phone:847-397-2300
Practice Address - Fax:847-397-6140
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
IL01622028OtherBLUE SHIELD
ILCI5064OtherRAILROAD MEDICARE
ILCI5064OtherRAILROAD MEDICARE