Provider Demographics
NPI:1629033469
Name:ADVANCED IMAGING OF DEERFIELD, LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING OF DEERFIELD, LLC
Other - Org Name:OPEN ADVANCED MRI OF DEERFIELD, LLC
Other - Org Type:Doing Business As
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:847-374-8100
Mailing Address - Street 1:2101 WAUKEGAN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-374-8100
Mailing Address - Fax:847-374-8125
Practice Address - Street 1:2101 WAUKEGAN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-374-8100
Practice Address - Fax:847-374-8125
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
IL04932007OtherBLUE SHIELD
ILCK4071OtherRAILROAD MEDICARE
IL200559Medicare ID - Type UnspecifiedGROUP NUMBER