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General NPI Number Information
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NPI Number | 1588190086
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Entity Type | Organization
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Legal Business Name | MAXIM MRI L.L.C.
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 23832 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-8000
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Country | US
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Telephone | 248-206-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 22000 GREENFIELD RD
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City | OAK PARK
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State | MI
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Zip | 48237-2500
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Country | US
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Telephone | 248-206-2990
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JENNIFER WATSON
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Credential |
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Telephone | 248-709-7072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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