Provider Demographics
NPI:1831328889
Name:MIDWEST OPEN MRI
Entity type:Organization
Organization Name:MIDWEST OPEN MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIRANJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-455-5552
Mailing Address - Street 1:7372 RTE 83
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4283
Mailing Address - Country:US
Mailing Address - Phone:630-455-5552
Mailing Address - Fax:630-455-1090
Practice Address - Street 1:8319 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1605
Practice Address - Country:US
Practice Address - Phone:708-450-9800
Practice Address - Fax:708-450-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0=========Medicaid
IL0=========Medicaid