MEDICARE: WAYNE MACOMB DIAGNOSTIC IMAGING CENTER 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	2085R0202X	Diagnostic Radiology Physician	2085R0202X	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000005320	OTHER	MI	CAPE MEDICAL
2	P42884	OTHER	MI	BLUE CARE NETWORK
3	104972	OTHER	MI	PREFERRED CHOICES
4	1207380001	OTHER	MI	WELLNESS PLAN
5	8331930	OTHER	MI	AETNA PPO
6	70097B	OTHER	MI	HEALTH ALLIANCE PLAN
7	148899	OTHER	MI	GREAT LAKES HEALTH PLAN
8	300E06144	OTHER	MI	BLUE CROSS
9	RA820051	OTHER	MI	M CARE
10	M015025	OTHER	MI	CHAMPUS-TRICARE
11	0525947	OTHER	MI	AETNA HMO

General Provider Information

NPI Number	:	1326042235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE MACOMB DIAGNOSTIC IMAGING CENTER INC

Provider Business Mailing Address
First Line	:	18245 E 10 MILE RD
Second Line	:	STE 100
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-5807
Country	:	US
Telephone Number	:	586-775-6400
Fax Number	:	586-498-1559

Provider Business Practice Location Address
First Line	:	8690 RELIABLE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	586-775-6400
Fax Number	:	586-498-1559

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	MRS. CAROLE ZUPAN
Credential	:
Telephone Number	:	586-435-2031

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/21/2012

Similar Medicare Providers

1235133141 — MACOMB MAGNETIC RESONANCE IMAGING CENTER INC
Practice Location Address:

8956 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 586-566-1590
Practice Fax: 586-498-1559

1467447268 — MARK B AUSTIN MD
Practice Location Address:

6810 RELIABLE PKWY
CHICAGO, IL
60686-0001

Practice Phone: 800-288-8325
Practice Fax:

1194775858 — DR. MANDAR A PATTEKAR M.D.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

1073563730 — MICHELLE Y REGEHR N.P.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

1528019437 — DR. CRAIG A FENTON M.D.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

1578514543 — DR. STEPHEN M SMITH M.D.
Practice Location Address:

5200 RELIABLE PARKWAY
CHICAGO, IL
60686-0001

Practice Phone: 309-671-8748
Practice Fax: 309-671-8740

Directions to “WAYNE MACOMB DIAGNOSTIC IMAGING CENTER INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.