Provider Demographics
NPI:1770621443
Name:AMERICAN MRI, INC.
Entity type:Organization
Organization Name:AMERICAN MRI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAZELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-933-6278
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:847-870-3600
Mailing Address - Fax:847-870-3500
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:847-870-3600
Practice Address - Fax:847-870-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3772-0384261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3772-0384OtherSTATE TAX ID#