Provider Demographics
NPI:1871821538
Name:MOBILE MEDICAL IMAGING SC
Entity Type:Organization
Organization Name:MOBILE MEDICAL IMAGING SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YOGESH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-226-7000
Mailing Address - Street 1:1901 RAYMOND DR
Mailing Address - Street 2:SUITE 19
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6720
Mailing Address - Country:US
Mailing Address - Phone:847-559-9150
Mailing Address - Fax:847-464-8057
Practice Address - Street 1:1901 RAYMOND DR
Practice Address - Street 2:SUITE 19
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6720
Practice Address - Country:US
Practice Address - Phone:847-559-9150
Practice Address - Fax:847-464-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085241207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDR6213Medicare PIN
ILIL3272Medicare PIN