Provider Demographics
NPI:1629469416
Name:MOBILE MRI STAFFING,LLC
Entity Type:Organization
Organization Name:MOBILE MRI STAFFING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-225-6909
Mailing Address - Street 1:3815 PINE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1650
Mailing Address - Country:US
Mailing Address - Phone:248-421-5809
Mailing Address - Fax:248-281-5905
Practice Address - Street 1:26699 W 12 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-281-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032840261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)