Provider Demographics
NPI:1235133141
Name:MACOMB MAGNETIC RESONANCE IMAGING CENTER INC
Entity type:Organization
Organization Name:MACOMB MAGNETIC RESONANCE IMAGING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-435-2031
Mailing Address - Street 1:42700 SCHOENHERR RD
Mailing Address - Street 2:STE 4
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2874
Mailing Address - Country:US
Mailing Address - Phone:586-566-1590
Mailing Address - Fax:586-498-1559
Practice Address - Street 1:8956 RELIABLE PARKWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60686-0001
Practice Address - Country:US
Practice Address - Phone:586-566-1590
Practice Address - Fax:586-498-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2085R0202X2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300E06180OtherBLUE CROSS
MI84784AOtherHEALTH ALLIANCE PLAN
MI1011238 0001OtherWELLNESS PLAN
MI8332744OtherAETNA PPO
MIP82732OtherBLUE CARE NETWORK
MI104904OtherPREFERRED CHOICES
MI029324OtherCHAMPUS TRICARE
MI148900OtherGREAT LAKES HEALTH PLAN
MI2377411OtherAETNA HMO
MIRA820057OtherM CARE
MI2377411OtherAETNA HMO