Provider Demographics
NPI:1598341042
Name:ADVANCED CLINICAL IMAGING LLC
Entity Type:Organization
Organization Name:ADVANCED CLINICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROSTIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-935-9761
Mailing Address - Street 1:1011 E TOUHY AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5829
Mailing Address - Country:US
Mailing Address - Phone:312-676-6648
Mailing Address - Fax:
Practice Address - Street 1:12 SALT CREEK LN STE 105
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8607
Practice Address - Country:US
Practice Address - Phone:312-676-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty