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  7. NPI Record 1770795718

MIDWEST RADIOLOGY ILLINOIS, LTD
Complete NPI Record 1770795718
Clinic/Center - Radiology, Mobile in Chicago, IL

NPI Status: Active since May 03, 2007

Contact Information

4955 N MILWAUKEE AVE
SUITE 8
CHICAGO, IL
ZIP 60630
Phone: (773) 736-6283
Fax: (773) 736-1403

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Is Organization Subpart
  31. Authorized Official Name Prefix Text

Complete NPI Dataset

This page represents the complete record for NPI 1770795718. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1770795718
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 4955 N MILWAUKEE AVE
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Second Line Business Mailing Address: SUITE 8
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: CHICAGO
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address State Name: IL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 606302286
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7737366283
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7737361403
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 4955 N MILWAUKEE AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 8
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address City Name: CHICAGO
The country code in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IL
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 606302286
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address Country Code If outside U S : US
The date that a record was last updated or changed.
Provider Business Practice Location Address Telephone Number: 7737366283
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider Business Practice Location Address Fax Number: 7737361403
The first name of the authorized official.
Provider Enumeration Date: 5/3/2007
The title or position of the authorized official.
Last Update Date: 8/22/2020
The 10-position telephone number of the authorized official.
Authorized Official Last Name: CHATELAIN
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Authorized Official First Name: PIERRE
Authorized Official Middle Name: ELIE
Authorized Official Title or Position: PRESIDENT
Authorized Official Telephone Number: 6302098405
Healthcare Provider Taxonomy Code 1: 261QR0208X
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.