Provider Demographics
NPI:1558326314
Name:OPEN ADVANCED MRI OF CHICAGO, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:HOULIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-795-9800
Mailing Address - Street 1:150 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7553
Mailing Address - Country:US
Mailing Address - Phone:312-795-9800
Mailing Address - Fax:312-795-0986
Practice Address - Street 1:150 N MICHIGAN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7553
Practice Address - Country:US
Practice Address - Phone:312-795-9800
Practice Address - Fax:312-795-0986
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
IL01622956OtherBLUE SHIELD
ILCG3784OtherRAILROAD MEDICARE
IL01622956OtherBLUE SHIELD