Provider Demographics
NPI:1184659864
Name:OAKLAND PARK MRI INC
Entity Type:Organization
Organization Name:OAKLAND PARK MRI INC
Other - Org Name:DPI OF FT LAUDERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:DEKKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-566-4551
Mailing Address - Street 1:PO BOX 5084
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-5084
Mailing Address - Country:US
Mailing Address - Phone:954-566-4551
Mailing Address - Fax:954-566-4565
Practice Address - Street 1:1799 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1537
Practice Address - Country:US
Practice Address - Phone:954-566-4551
Practice Address - Fax:954-566-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2866OtherBLUE CROSS BLUE SHIELD
FL3860891OtherAETNA
FLE5750Medicare PIN