LONGEVITY CENTERS OF ILLINOIS LLC NPI 1093427593

NPI Information

NPI: 1093427593
Provider Name: LONGEVITY CENTERS OF ILLINOIS LLC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

CLIA Number: 14D2278534

Address:
550 N LAKE ST STE 1
MUNDELEIN, IL
ZIP 60060
Phone: (847) 593-8460
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LONGEVITY CENTERS OF ILLINOIS LLC is a diagnostic radiology radiology in Mundelein, IL. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. LONGEVITY CENTERS OF ILLINOIS LLC NPI is 1093427593. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

550 N LAKE ST STE 1
MUNDELEIN, IL
ZIP 60060-827
Phone: (847) 593-8460

The provider's authorized official is Yan Katsnelson .
The authorized official title is Ceo and has the following contact phone number (847) 774-5300.

The CLIA number assigned to this NPI record is 14D2278534 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/16/2022 and was last updated on 4/16/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207RI0011X	Internal Medicine	Interventional Cardiology	No
2	2085R0202X	Radiology	Diagnostic Radiology	Yes
3	2085R0204X	Radiology	Vascular & Interventional Radiology	No
4	261QP2300X	Clinic/Center	Primary Care	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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