Organization
OPEN MRI OF DELAFIELD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN SAGE (MEMBER MANAGER)
(877) 444-4540
Entity
Organization
Contact information
Practice address
3960 HILLSIDE DR, SUITE 106, DELAFIELD, WI 53018-2148
(262) 646-6950
(262) 646-7098
Mailing address
1616 E ROOSEVELT RD, SUITE 5, WHEATON, IL 60187-6850
(877) 444-4540
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21263000
—
WI
01
—
P000043204
RAIL ROAD PIN
—
Enumeration date
05/24/2006
Last updated
01/01/2012
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