| Organization Name: | MIDWEST ADVANCED RADIOLOGY CENTER, LLC |
| NPI Number: | 1104263763 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN WILLIAM SALDANHA (MANAGER) |
| Mailing Address: | 22285 N Pepper Rd Ste 103 Lake Barrington |
| State: | IL US |
| Postal Code: | 600102539 |
| Phone Number: | 8472770936 |
| Fax Number: | 8472770945 |
| NPI Enumeration Date: | 05/22/2013 |
| NPI Last Update Date: | 05/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |