MEDICARE: IMAGING ASSOCIATES OF MICHIGAN PLLC

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

General Provider Information

NPI Number	:	1164943007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGING ASSOCIATES OF MICHIGAN PLLC

Provider Business Mailing Address
First Line	:	PO BOX 85517
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W BARAGA AVE
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-214-2900
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	330-309-6984

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	03/20/2026

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