Healthcare Provider Details

I. General information

NPI: 1659549012
Provider Name (Legal Business Name): MICHIGAN DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 INKSTER RD STE 120
BLOOMFIELD HILLS MI
48301-1310
US

IV. Provider business mailing address

6431 INKSTER RD STE 120
BLOOMFIELD HILLS MI
48301-1310
US

V. Phone/Fax

Practice location:
  • Phone: 248-550-0111
  • Fax: 248-550-0121
Mailing address:
  • Phone: 248-550-0111
  • Fax: 248-550-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ATHEIR AMARRAH
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 248-550-0111