Healthcare Provider Details

I. General information

NPI: 1093950578
Provider Name (Legal Business Name): MICHIGAN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 TELEGRAPH RD SUITE 185
BINGHAM FARMS MI
48025-4519
US

IV. Provider business mailing address

30150 TELEGRAPH RD SUITE 185
BINGHAM FARMS MI
48025-4519
US

V. Phone/Fax

Practice location:
  • Phone: 248-593-1087
  • Fax:
Mailing address:
  • Phone: 248-593-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY LAUHOFF
Title or Position: PRESIDENT
Credential:
Phone: 248-593-1087