Provider Demographics
NPI:1457738155
Name:MOLECULAR IMAGING CHICAGO LLC
Entity type:Organization
Organization Name:MOLECULAR IMAGING CHICAGO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:BATRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-258-2384
Mailing Address - Street 1:1 TRANS AM PLAZA DRIVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4364
Mailing Address - Country:US
Mailing Address - Phone:630-827-2502
Mailing Address - Fax:630-242-8450
Practice Address - Street 1:4932 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:708-499-9700
Practice Address - Fax:630-242-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF300194852Medicare PIN