Provider Demographics
NPI:1467408872
Name:ADVANTAGE MRI-LOGAN SQUARE, LLC
Entity Type:Organization
Organization Name:ADVANTAGE MRI-LOGAN SQUARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAIFA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-728-8767
Mailing Address - Street 1:2008 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3767
Mailing Address - Country:US
Mailing Address - Phone:773-227-9777
Mailing Address - Fax:773-227-9888
Practice Address - Street 1:2008 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3767
Practice Address - Country:US
Practice Address - Phone:773-227-9777
Practice Address - Fax:773-227-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty