| Blue Water Open Mri | |
|
1201 Stone St Suite 8 Port Huron MI 48060-3563 | |
| (810) 989-0000 | |
| Not Available |
| Full Name | Blue Water Open Mri |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1201 Stone St, Port Huron, Michigan |
| Authorized Official Name and Position | Marwan I Shuayto (PHYSICIAN) |
| Authorized Official Contact | 8109890000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Water Open Mri 615 Pine St Port Huron MI 48060-5400 Ph: (810) 989-0000 | Blue Water Open Mri 1201 Stone St Suite 8 Port Huron MI 48060-3563 Ph: (810) 989-0000 |
| NPI Number | 1578819850 |
|---|---|
| Provider Enumeration Date | 07/24/2012 |
| Last Update Date | 06/25/2020 |
| Certification Date | 06/25/2020 |
| Medicare PECOS PAC ID | 3072764596 |
|---|---|
| Medicare Enrollment ID | O20121109000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578819850 | NPI | - | NPPES |
| Provider Name | Frank Fayz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104856145 PECOS PAC ID: 7315841475 Enrollment ID: I20040812000816 |
| Provider Name | John J Ference |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861404618 PECOS PAC ID: 9436193612 Enrollment ID: I20050617000906 |
| Provider Name | David P Tracy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033121892 PECOS PAC ID: 0143264333 Enrollment ID: I20050617000929 |
| Provider Name | Leopold M Fregoli |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942212709 PECOS PAC ID: 3678517869 Enrollment ID: I20050617000947 |
| Provider Name | Daniel K Shogren |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629080486 PECOS PAC ID: 2668416850 Enrollment ID: I20050617000963 |
| Provider Name | Omar Amin Turk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407824634 PECOS PAC ID: 4082621719 Enrollment ID: I20060321000318 |
| Provider Name | Marwan I Shuayto |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1841383924 PECOS PAC ID: 8527060045 Enrollment ID: I20070712000457 |
| Provider Name | Edward J Mauch |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063628154 PECOS PAC ID: 4183775745 Enrollment ID: I20090623000138 |
| Provider Name | Devin R South |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073742797 PECOS PAC ID: 8820137342 Enrollment ID: I20091123000280 |
| Provider Name | Syed Abbas H Moosavi |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1912227455 PECOS PAC ID: 7416081013 Enrollment ID: I20100818000650 |
| Provider Name | Hafeez Y Ahmed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871758326 PECOS PAC ID: 4587806559 Enrollment ID: I20130805000553 |
| Provider Name | Angela Kathleen Otoole |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1659331023 PECOS PAC ID: 6901034719 Enrollment ID: I20140123001625 |
| Provider Name | Janette C Guertin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619361870 PECOS PAC ID: 4486957701 Enrollment ID: I20160120002310 |
| Provider Name | Stacy J Ries |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912293036 PECOS PAC ID: 4789977695 Enrollment ID: I20160728002269 |
| Provider Name | Jonathan R Gupta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033407499 PECOS PAC ID: 2860776762 Enrollment ID: I20170221000523 |
| Provider Name | Carol Hilliker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558833632 PECOS PAC ID: 1052651627 Enrollment ID: I20190318001387 |
| Provider Name | Todd Greenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063410421 PECOS PAC ID: 8123926821 Enrollment ID: I20200228001656 |
| Provider Name | Michael Rozenfeld |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891937454 PECOS PAC ID: 6305137043 Enrollment ID: I20200303000593 |
| Provider Name | Sean L Johnston |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477581866 PECOS PAC ID: 0547152340 Enrollment ID: I20200303002514 |
| Provider Name | Jodie Bechtell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568752947 PECOS PAC ID: 9638586449 Enrollment ID: I20210323001614 |
| Provider Name | Karen Allyse Rosen-wasserman |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1679932206 PECOS PAC ID: 7315360484 Enrollment ID: I20220127002568 |
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