Provider Demographics
NPI:1841237906
Name:GREAT LAKES MRI SPECIALISTS LLC
Entity Type:Organization
Organization Name:GREAT LAKES MRI SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-705-1100
Mailing Address - Street 1:PO BOX 7150
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-7150
Mailing Address - Country:US
Mailing Address - Phone:231-922-2245
Mailing Address - Fax:231-922-9073
Practice Address - Street 1:2922 D AND M DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-7417
Practice Address - Country:US
Practice Address - Phone:231-922-2245
Practice Address - Fax:231-922-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P25350Medicare ID - Type Unspecified