OPEN MRI OF MICHIGAN LLC (NPI# 1275570848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275570848 |
| Entity Type | Organization |
| Organization Name | OPEN MRI OF MICHIGAN LLC |
| Other Organization Name | ST JOHN OPEN MRI OF MICHIGAN LLC |
| Practice Address |
411 W 13 Mile Rd Ste 200 Madison Heights MI 48071-1526 |
| Mailing Address |
Po Box 67000 Department 18401 Detroit MI 48267-1841 |
| Practice Telephone | 2485854569 |
| Practice Fax Number | 2485854620 |
| Mailing Telephone | 5862284607 |
| Mailing Fax Number | 5862284666 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RONALD W JESMORE (CORPORATE DIRECTOR) |
| Authorized Official Telephone | 5862266987 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MIDWEST HEALTH PLAN | 001269 | 01 | |
| BCBS | 0F30087 | 01 | |
| CARE CHOICES | 135843 | 01 | |
| ONE CALL MEDICAL | M1670 | 01 | |
| BCN OLD PROVIDER # | P116959 | 01 | |
| AETNA | 7282452 | 01 | |
| CIGNA | 8263818 | 01 | |
| MCARE | RA16206 | 01 | |
| HAP | 0N68190 | 01 | |
| GREAT LAKES HEALTH PLAN | 139709 | 01 | |
| CAPE | 8265 | 01 | |
| MOLINA | QMXPR0021565 | 01 |
| Other Name | Type Code |
|---|---|
| St John Open MRI of Michigan LLC | Other Name - Individual/Organization |
| Street Address |
411 W 13 MILE RD STE 200 |
| City | MADISON HEIGHTS |
| State | MI |
| Zip Code | 48071-1526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063605848 | Open Mri of Michigan | Clinic/Center | 411 W 13 Mile Rd, Suite 200, Madison Heights, MI 48071-1536 | 2007-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952918831 | United Medical Laboratory LLC | Clinical Medical Laboratory | 30675 Stephenson Hwy, Suite B, Madison Heights, MI 48071 | 2020-09-25 |
| 1033776372 | Terry Ky-sieu Tran | Student in an Organized Health Care Education/Training Program | 27351 Dequindre Rd., Madison Height, MI 48071 | 2019-05-22 |
| 1942865894 | Jordan Lee Stav | Student in an Organized Health Care Education/Training Program | Sjmo Emergency Medicine Residency Program, 27351 Dequindre Rd, Madison Heights, MI 48071 | 2019-05-07 |
| 1538624960 | Holistic Therapy Institute Physical Therapy, Inc. | Physical Therapist | 30201 Dequidre Rd Suite1, Madison Hts, MI 48071 | 2019-02-11 |
| 1720558216 | Kevin Luce | Physical Therapy Assistant | 1433 E 12 Mile Road, Madison Heights, MI 48071 | 2018-11-28 |
| 1861974297 | Olubunmi Oluremi Aluko | Physical Therapist | 1410 E.14 Mile Road, Madison Heights, MI 48071 | 2018-09-01 |
| 1558859579 | Leslie G Lafer, Dopllc | Obstetrics & Gynecology | 1437 E 12 Mile Road, Building D, Madison Heights, MI 48071 | 2018-04-25 |
| 1588161020 | Daniel Eugene Geer | Physical Therapist | 1410 E 14 Mile Road, Madison Heights, MI 48071 | 2018-04-11 |
| 1881100931 | Medshop Pharmacy LLC | Pharmacy | 30549 Stephenson Hwy Ste B, Madison Heights, MI 48071 | 2017-12-26 |
| 1730602004 | Ali Bazzy | Nurse Practitioner | 27483 Dequindre Suite 304, Madison Hgts, MI 48071 | 2017-07-19 |
| Find all providers in zip 48071 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457361792 | Lisa M Porter-grenn | Radiology | 27379 Dequindre, Madison Heights, MI 48071 | 2006-08-09 |
| 1366996829 | University Neurosurgical Associates, PC | Radiology | 30781 Stephenson Hwy, Madison Heights, MI 48071-1618 | 2016-08-12 |
| 1326231325 | Syed Mahmood Ali Khan | Radiology | 27483 Dequindre Rd, Suite 101, Madison Heights, MI 48071-3491 | 2007-08-22 |
| 1780697425 | Roger B Fenton | Radiology | 27379 Dequindre, Madison Heights, MI 48071 | 2006-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245855667 | Joshua Boulter | Radiology | 2250 Providence Drive, 3pmb Suite #301, Southfield, MI 48075-4818 | 2020-06-11 |
| 1679197693 | Shyam Amin | Radiology | Academic Internal Medicine 2 2250 Providence Dr, 3pmb Suite #301, Southfield, MI 48075-4818 | 2020-06-05 |
| 1871116509 | Anthony Diebes | Radiology | 16001 W 9 Mile Rd Bldg 4th, Southfield, MI 48075-4818 | 2020-05-28 |
| 1548823800 | Alexander Paul Kaechele | Radiology | 16001 West 9 Mile Road, Suite #416, Southfield, MI 48075-4818 | 2019-04-22 |
| 1790246627 | Genesis Healthcare | Radiology | 8560 N Silvery Ln Ste 101, Dearborn Heights, MI 48127-4516 | 2019-03-25 |
| 1023572831 | Proscan Imaging Southfield Pllc | Radiology | 29877 Telegraph Rd # 11, Southfield, MI 48034-1332 | 2019-01-25 |
| 1295204253 | Easy Imaging, LLC | Radiology | 16100 19 Mile Rd Ste X, Clinton Township, MI 48038-1148 | 2018-11-20 |
| 1205304888 | Ascension Medical Group Genesys | Radiology | 1096 S Belsay Rd Ste J, Burton, MI 48509-1948 | 2018-11-13 |
| 1336626696 | Quantum Medical Radiology of California, P.C. | Radiology | 1625 Bear Creek Ln Unit O, Petoskey, MI 49770-8378 | 2018-07-19 |
| 1376072488 | Cambridge Institute of Minimally Invasive Therapies Pllc | Radiology | 2007 E 14 Mile Rd, Sterling Heights, MI 48310-5905 | 2017-06-12 |
| Find all providers with the same taxonomy | ||||
| City | MADISON HEIGHTS |
| Zip Code | 48071 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.