Healthcare Provider Details

I. General information

NPI: 1184659864
Provider Name (Legal Business Name): OAKLAND PARK MRI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 W OAKLAND PARK BLVD SUITE 105
OAKLAND PARK FL
33311-1537
US

IV. Provider business mailing address

PO BOX 5084
FT LAUDERDALE FL
33310-5084
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-4551
  • Fax: 954-566-4565
Mailing address:
  • Phone: 954-566-4551
  • Fax: 954-566-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD STEPHAN DEKKERS
Title or Position: CEO
Credential:
Phone: 954-566-4551