Provider Demographics
NPI:1760447502
Name:OPEN ADVANCED MRI OF WHEATON, LLC
Entity Type:Organization
Organization Name:OPEN ADVANCED MRI OF WHEATON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-510-7050
Mailing Address - Street 1:43 DANADA SQ E
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8484
Mailing Address - Country:US
Mailing Address - Phone:630-510-7050
Mailing Address - Fax:630-510-3699
Practice Address - Street 1:43 DANADA SQ E
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8484
Practice Address - Country:US
Practice Address - Phone:630-510-7050
Practice Address - Fax:630-510-3699
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
IL02222285OtherBLUE SHIELD
ILCI7538OtherRAILROAD MEDICARE
IL588120Medicare ID - Type UnspecifiedGROUP NUMBER