Provider Demographics
NPI:1063605848
Name:OPEN MRI OF MICHIGAN
Entity type:Organization
Organization Name:OPEN MRI OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-228-4560
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:877-996-9975
Mailing Address - Fax:586-228-4533
Practice Address - Street 1:411 W 13 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1536
Practice Address - Country:US
Practice Address - Phone:248-585-4569
Practice Address - Fax:248-585-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F30087OtherBCBSM GROUP NUMBER
MI0F30087OtherBCBSM GROUP NUMBER