Provider Demographics
NPI:1386818466
Name:CHICAGO MAXILLOFACIAL IMAGING
Entity Type:Organization
Organization Name:CHICAGO MAXILLOFACIAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-327-2400
Mailing Address - Street 1:2449 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2414
Mailing Address - Country:US
Mailing Address - Phone:773-327-2400
Mailing Address - Fax:773-327-4759
Practice Address - Street 1:2449 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2414
Practice Address - Country:US
Practice Address - Phone:773-327-2400
Practice Address - Fax:773-327-4759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LINCOLN PARK INSTITUTE FOR ORAL AND MAXILLOFACIAL SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty