NPI 1386761203

Advantage Diagnostic Imaging Center - Chicago, LLC

Organisation Exclusive Provider Organization Mokena, IL

Practice location

Address: 19065 Hickory Creek Pl Suite 240, Mokena, IL 60448-8507
Phone: (708) 478-6417
Fax: (708) 535-8087

Authorised official

Name: Jim Kolb
Title: Executive Vice President
Phone: (708) 478-6403

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1386761203
Entity type: Organization
NPI issued: 24 Mar 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.