Provider Demographics
NPI:1568496511
Name:ENHANCED MEDICAL IMAGING OF ELGIN LLC
Entity type:Organization
Organization Name:ENHANCED MEDICAL IMAGING OF ELGIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:WNUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-925-0990
Mailing Address - Street 1:520 58TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4115
Mailing Address - Country:US
Mailing Address - Phone:262-925-0990
Mailing Address - Fax:
Practice Address - Street 1:750 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4703
Practice Address - Country:US
Practice Address - Phone:847-841-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
214611Medicare PIN