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General NPI Number Information
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NPI Number | 1275570848
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF MICHIGAN LLC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 W 13 MILE RD STE 200
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-1526
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Country | US
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Telephone | 248-585-4569
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Fax | 248-585-4620
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DEPARTMENT 18401
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City | DETROIT
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State | MI
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Zip | 48267-1841
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Country | US
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Telephone | 586-228-4607
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Fax | 586-228-4666
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Authorized Official
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Title or Position | CORPORATE DIRECTOR
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Name | RONALD W JESMORE
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Credential |
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Telephone | 586-226-6987
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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 |
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License Number State | MI
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