Provider Demographics
NPI:1497149926
Name:NORTHSTAR IMAGING LLC
Entity Type:Organization
Organization Name:NORTHSTAR IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-227-9606
Mailing Address - Street 1:8053 E BLOOMINGTON FWY
Mailing Address - Street 2:#450
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4577
Mailing Address - Country:US
Mailing Address - Phone:612-227-9606
Mailing Address - Fax:
Practice Address - Street 1:8053 E BLOOMINGTON FWY
Practice Address - Street 2:#450
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4577
Practice Address - Country:US
Practice Address - Phone:612-227-9606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4848261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology