Provider Demographics
NPI:1891805891
Name:OPEN IMAGING, LLC
Entity Type:Organization
Organization Name:OPEN IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNABALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-619-9771
Mailing Address - Street 1:30781 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1618
Mailing Address - Country:US
Mailing Address - Phone:248-583-8922
Mailing Address - Fax:248-583-8969
Practice Address - Street 1:4447 TALMADGE RD
Practice Address - Street 2:SUITE H
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3500
Practice Address - Country:US
Practice Address - Phone:248-583-8922
Practice Address - Fax:248-583-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH745471OtherBUCKEYE COMMUNITY HEALTH
OH000000494711OtherANTHEM BLUE CROSS
OH2742189Medicaid
OH000000494711OtherANTHEM BLUE CROSS