MEDICARE: OPEN MRI OF MICHIGAN LLC

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		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0F30087	OTHER	BCBS
2	8265	OTHER	CAPE
3	P116959	OTHER	BCN OLD PROVIDER #
4	0N68190	OTHER	HAP
5	139709	OTHER	GREAT LAKES HEALTH PLAN
6	7282452	OTHER	AETNA
7	001269	OTHER	MIDWEST HEALTH PLAN
8	135843	OTHER	CARE CHOICES
9	8263818	OTHER	CIGNA
10	QMXPR0021565	OTHER	MOLINA
11	M1670	OTHER	ONE CALL MEDICAL
12	RA16206	OTHER	MCARE

General Provider Information

NPI Number	:	1275570848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF MICHIGAN LLC

Provider Business Mailing Address
First Line	:	PO BOX 67000
Second Line	:	DEPARTMENT 18401
City	:	DETROIT
State	:	MI
Zip	:	48267-1841
Country	:	US
Telephone Number	:	586-228-4607
Fax Number	:	586-228-4666

Provider Business Practice Location Address
First Line	:	411 W 13 MILE RD
Second Line	:	STE 200
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1526
Country	:	US
Telephone Number	:	248-585-4569
Fax Number	:	248-585-4620

Authorized Official
Title or Position	:	CORPORATE DIRECTOR
Name	:	RONALD W JESMORE
Credential	:
Telephone Number	:	586-226-6987

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/22/2020

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Directions to “OPEN MRI OF MICHIGAN LLC ” Practice Location

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