MEDICARE: OAKLAND PARK MRI INC

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	261QR0200X	Radiology Clinic/Center
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V2866	OTHER	FL	BLUE CROSS BLUE SHIELD
2	3860891	OTHER	FL	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184659864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND PARK MRI INC

Provider Business Mailing Address
First Line	:	PO BOX 5084
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33310-5084
Country	:	US
Telephone Number	:	954-566-4551
Fax Number	:	954-566-4565

Provider Business Practice Location Address
First Line	:	1799 W OAKLAND PARK BLVD
Second Line	:	SUITE 105
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1537
Country	:	US
Telephone Number	:	954-566-4551
Fax Number	:	954-566-4565

Authorized Official
Title or Position	:	CEO
Name	:	MR. HOWARD STEPHAN DEKKERS
Credential	:
Telephone Number	:	954-566-4551

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/13/2008

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Directions to “OAKLAND PARK MRI INC ” Practice Location

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