Organization
OPEN MRI OF MICHIGAN LLC
Active
Other names
St John Open MRI of Michigan LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD W JESMORE (CORPORATE DIRECTOR)
(586) 226-6987
Entity
Organization
Contact information
Practice address
411 W 13 MILE RD, STE 200, MADISON HEIGHTS, MI 48071-1526
(248) 585-4569
(248) 585-4620
Mailing address
PO BOX 67000, DEPARTMENT 18401, DETROIT, MI 48267-1841
(586) 228-4607
(586) 228-4666
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001269
MIDWEST HEALTH PLAN
—
01
—
0F30087
BCBS
—
01
—
0N68190
HAP
—
01
—
135843
CARE CHOICES
—
01
—
139709
GREAT LAKES HEALTH PLAN
—
01
—
7282452
AETNA
—
01
—
8263818
CIGNA
—
01
—
8265
CAPE
—
01
—
M1670
ONE CALL MEDICAL
—
01
—
P116959
BCN OLD PROVIDER #
—
01
—
QMXPR0021565
MOLINA
—
01
—
RA16206
MCARE
—
Enumeration date
06/01/2006
Last updated
08/22/2020
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