Provider Demographics
NPI:1780826230
Name:DIVISION MRI, INC.
Entity Type:Organization
Organization Name:DIVISION MRI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-456-3384
Mailing Address - Street 1:PO BOX 220450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-0450
Mailing Address - Country:US
Mailing Address - Phone:773-235-7455
Mailing Address - Fax:773-235-7055
Practice Address - Street 1:2618 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7107
Practice Address - Country:US
Practice Address - Phone:773-235-7455
Practice Address - Fax:773-235-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory