Healthcare Provider Details

I. General information

NPI: 1154653087
Provider Name (Legal Business Name): NUCLEAR CARDIAC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 S HURON RD SUITE 2
BAY CITY MI
48706-1547
US

IV. Provider business mailing address

PO BOX 398
KAWKAWLIN MI
48631-0398
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-6980
  • Fax: 989-488-4444
Mailing address:
  • Phone: 989-667-6780
  • Fax: 989-488-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberDS112843
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE J SHARRARD
Title or Position: CEO/OWNER
Credential: RTN
Phone: 989-326-0929