Provider Demographics
NPI:1316839749
Name:IMGE, LLC
Entity type:Organization
Organization Name:IMGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-927-6926
Mailing Address - Street 1:444 S RAND RD STE 211
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2307
Mailing Address - Country:US
Mailing Address - Phone:224-475-1223
Mailing Address - Fax:
Practice Address - Street 1:444 S RAND RD STE 211
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2307
Practice Address - Country:US
Practice Address - Phone:224-475-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty