Basic Information
| Provider Information | |||||||||
| NPI: | 1114953577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN MRI AT CORPORATE WOODS LLC | ||||||||
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| OtherOrganizationName: | OPEN MRI AT CORPORATE WOODS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5775 WAYZATA BOULEVARD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525428553 | ||||||||
| FaxNumber: | 9525136880 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 CORPORATE WOODS PKWY | ||||||||
| Address2: | |||||||||
| City: | VERNON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600613111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478830308 | ||||||||
| FaxNumber: | 8478830318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 06/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | JACOBSEN | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER OF THE BOARD SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9525436500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.