Provider Demographics
NPI:1275570848
Name:OPEN MRI OF MICHIGAN LLC
Entity Type:Organization
Organization Name:OPEN MRI OF MICHIGAN LLC
Other - Org Name:ST JOHN OPEN MRI OF MICHIGAN LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:JESMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-226-6987
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 18401
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-1841
Mailing Address - Country:US
Mailing Address - Phone:586-228-4607
Mailing Address - Fax:586-228-4666
Practice Address - Street 1:411 W 13 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1526
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:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F30087OtherBCBS
8265OtherCAPE
P116959OtherBCN OLD PROVIDER #
0N68190OtherHAP
139709OtherGREAT LAKES HEALTH PLAN
7282452OtherAETNA
001269OtherMIDWEST HEALTH PLAN
135843OtherCARE CHOICES
8263818OtherCIGNA
QMXPR0021565OtherMOLINA
M1670OtherONE CALL MEDICAL
RA16206OtherMCARE
8263818OtherCIGNA
MI0N68190Medicare ID - Type Unspecified