Healthcare Provider Details

I. General information

NPI: 1801194865
Provider Name (Legal Business Name): MICHIGAN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 11/24/2014
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: 248-307-9557
Mailing address:
  • Phone: 248-593-1087
  • Fax: 248-307-9557

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 Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEFF LAUHOFF
Title or Position: VP OPERATIONS
Credential:
Phone: 248-593-1087