Provider Demographics
NPI:1568721140
Name:STAR BRIGHT IMAGE GROUP, LLC
Entity Type:Organization
Organization Name:STAR BRIGHT IMAGE GROUP, LLC
Other - Org Name:OAK PARK IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-469-1111
Mailing Address - Street 1:13161 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-4630
Mailing Address - Country:US
Mailing Address - Phone:248-291-6710
Mailing Address - Fax:248-291-6718
Practice Address - Street 1:13161 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-4630
Practice Address - Country:US
Practice Address - Phone:248-291-6710
Practice Address - Fax:248-291-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID66715OtherSTATE LICENCE NUMBER