| Organization Name: | MOLECULAR IMAGING OF WOOD DALE, LLC |
| NPI Number: | 1306016530 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALICE GARDNER (MANAGER) |
| Mailing Address: | 199 S Addison Rd Ste 107b Wood Dale |
| State: | IL US |
| Postal Code: | 601911929 |
| Phone Number: | 6306946300 |
| Fax Number: | 6303256390 |
| NPI Enumeration Date: | 03/04/2008 |
| NPI Last Update Date: | 03/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |