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General NPI Number Information
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NPI Number | 1235133141
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Entity Type | Organization
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Legal Business Name | MACOMB MAGNETIC RESONANCE IMAGING CENTER INC
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 8956 RELIABLE PARKWAY
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City | CHICAGO
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State | IL
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Zip | 60686-0001
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Country | US
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Telephone | 586-566-1590
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Fax | 586-498-1559
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Provider Business Mailing Address
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Address Line | 42700 SCHOENHERR RD STE 4
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-2874
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Country | US
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Telephone | 586-566-1590
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Fax | 586-498-1559
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | CAROL ZUPAN
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Credential |
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Telephone | 586-435-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2085R0202X
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License Number State | MI
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