Provider Demographics
NPI:1467497065
Name:MICHIGAN OPEN MRI LLC
Entity Type:Organization
Organization Name:MICHIGAN OPEN MRI LLC
Other - Org Name:CENTRAL MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-543-7226
Mailing Address - Street 1:26454 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0919
Mailing Address - Country:US
Mailing Address - Phone:248-543-7226
Mailing Address - Fax:248-399-7226
Practice Address - Street 1:26454 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0919
Practice Address - Country:US
Practice Address - Phone:248-543-7226
Practice Address - Fax:248-399-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63-C726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P02340Medicare PIN