Provider Demographics
NPI:1366490740
Name:MORTON GROVE MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:MORTON GROVE MEDICAL IMAGING, LLC
Other - Org Name:3T IMAGING OF MORTON GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-213-2700
Mailing Address - Street 1:9000 WAUKEGAN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2111
Mailing Address - Country:US
Mailing Address - Phone:847-213-2700
Mailing Address - Fax:847-213-2700
Practice Address - Street 1:9000 WAUKEGAN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2111
Practice Address - Country:US
Practice Address - Phone:847-213-2700
Practice Address - Fax:847-213-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology