Provider Demographics
NPI:1336467463
Name:MIDWEST OPEN MRI OF ILLINOIS LTD
Entity Type:Organization
Organization Name:MIDWEST OPEN MRI OF ILLINOIS LTD
Other - Org Name:WESTERN OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:708-788-8900
Mailing Address - Street 1:7049 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2137
Mailing Address - Country:US
Mailing Address - Phone:708-788-8900
Mailing Address - Fax:708-788-5110
Practice Address - Street 1:7049 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2137
Practice Address - Country:US
Practice Address - Phone:708-788-8900
Practice Address - Fax:708-788-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360436692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043669Medicaid