Organization
WAYNE MACOMB DIAGNOSTIC IMAGING CENTER INC
Active
Other names
Wayne Macomb MRI Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROLE ZUPAN (ADMINISTRATIVE DIRECTOR)
(586) 435-2031
Entity
Organization
Contact information
Practice address
8690 RELIABLE, CHICAGO, IL 60686-0001
(586) 775-6400
(586) 498-1559
Mailing address
18245 E 10 MILE RD, STE 100, ROSEVILLE, MI 48066-5807
(586) 775-6400
(586) 498-1559
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2085R0202X
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000005320
CAPE MEDICAL
MI
01
—
0525947
AETNA HMO
MI
01
—
104972
PREFERRED CHOICES
MI
01
—
1207380001
WELLNESS PLAN
MI
01
—
148899
GREAT LAKES HEALTH PLAN
MI
01
—
300E06144
BLUE CROSS
MI
01
—
70097B
HEALTH ALLIANCE PLAN
MI
01
—
8331930
AETNA PPO
MI
01
—
M015025
CHAMPUS-TRICARE
MI
01
—
P42884
BLUE CARE NETWORK
MI
01
—
RA820051
M CARE
MI
Enumeration date
06/09/2005
Last updated
03/21/2012
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