Provider Demographics
NPI:1770795718
Name:MIDWEST RADIOLOGY ILLINOIS, LTD
Entity type:Organization
Organization Name:MIDWEST RADIOLOGY ILLINOIS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:ELIE
Authorized Official - Last Name:CHATELAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-209-8405
Mailing Address - Street 1:4955 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2286
Mailing Address - Country:US
Mailing Address - Phone:773-736-6283
Mailing Address - Fax:773-736-1403
Practice Address - Street 1:4955 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2286
Practice Address - Country:US
Practice Address - Phone:773-736-6283
Practice Address - Fax:773-736-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile