Provider Demographics
NPI:1841423696
Name:ADVANCED MEDICAL IMAGING OF JOLIET, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL IMAGING OF JOLIET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-893-1919
Mailing Address - Street 1:1126 S 70TH ST
Mailing Address - Street 2:SUITE N500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3151
Mailing Address - Country:US
Mailing Address - Phone:414-455-4780
Mailing Address - Fax:414-475-2936
Practice Address - Street 1:330 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6565
Practice Address - Country:US
Practice Address - Phone:815-609-4988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDI II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty