MEDICARE: MACOMB MAGNETIC RESONANCE IMAGING CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	2085R0202X	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300E06180	OTHER	MI	BLUE CROSS
2	84784A	OTHER	MI	HEALTH ALLIANCE PLAN
3	1011238 0001	OTHER	MI	WELLNESS PLAN
4	8332744	OTHER	MI	AETNA PPO
5	P82732	OTHER	MI	BLUE CARE NETWORK
6	104904	OTHER	MI	PREFERRED CHOICES
7	029324	OTHER	MI	CHAMPUS TRICARE
8	148900	OTHER	MI	GREAT LAKES HEALTH PLAN
9	2377411	OTHER	MI	AETNA HMO
10	RA820057	OTHER	MI	M CARE

General Provider Information

NPI Number	:	1235133141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACOMB MAGNETIC RESONANCE IMAGING CENTER INC

Provider Business Mailing Address
First Line	:	42700 SCHOENHERR RD
Second Line	:	STE 4
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-2874
Country	:	US
Telephone Number	:	586-566-1590
Fax Number	:	586-498-1559

Provider Business Practice Location Address
First Line	:	8956 RELIABLE PARKWAY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	586-566-1590
Fax Number	:	586-498-1559

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	CAROL ZUPAN
Credential	:
Telephone Number	:	586-435-2031

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/21/2012

Similar Medicare Providers

1326042235 — WAYNE MACOMB DIAGNOSTIC IMAGING CENTER INC
Practice Location Address:

8690 RELIABLE
CHICAGO, IL
60686-0001

Practice Phone: 586-775-6400
Practice Fax: 586-498-1559

1467447268 — MARK B AUSTIN MD
Practice Location Address:

6810 RELIABLE PKWY
CHICAGO, IL
60686-0001

Practice Phone: 800-288-8325
Practice Fax:

1194775858 — DR. MANDAR A PATTEKAR M.D.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

1073563730 — MICHELLE Y REGEHR N.P.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

1528019437 — DR. CRAIG A FENTON M.D.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

1578514543 — DR. STEPHEN M SMITH M.D.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

Directions to “MACOMB MAGNETIC RESONANCE IMAGING CENTER INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.