Provider Demographics
NPI:1366697567
Name:ADVANCED BREAST IMAGING LLC
Entity type:Organization
Organization Name:ADVANCED BREAST IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-390-1240
Mailing Address - Street 1:1700 W CENTRAL RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2474
Mailing Address - Country:US
Mailing Address - Phone:224-764-4110
Mailing Address - Fax:
Practice Address - Street 1:1700 W CENTRAL RD
Practice Address - Street 2:SUITE 50
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2474
Practice Address - Country:US
Practice Address - Phone:224-764-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty