Provider Demographics
NPI:1831123454
Name:OPENSIDED MRI OF MILWAUKEE LLC
Entity Type:Organization
Organization Name:OPENSIDED MRI OF MILWAUKEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-217-7114
Mailing Address - Street 1:10919 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:888-606-6736
Mailing Address - Fax:414-257-3967
Practice Address - Street 1:10919 W BLUEMOUND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:888-606-6736
Practice Address - Fax:414-257-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32518100Medicaid