Healthcare Provider Details

I. General information

NPI: 1154338051
Provider Name (Legal Business Name): CENTER ROAD SCANNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WALLI STRASSE STE A
BURTON MI
48509
US

IV. Provider business mailing address

PO BOX 4459
FLINT MI
48504-0459
US

V. Phone/Fax

Practice location:
  • Phone: 810-742-4022
  • Fax: 810-742-4471
Mailing address:
  • Phone: 810-424-4761
  • Fax: 810-424-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301042515
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301034123
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301031588
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301057046
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301034675
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301037709
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301046932
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301406912
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301037112
License Number StateMI

VIII. Authorized Official

Name: DR. APPARAO MUKKAMALA
Title or Position: PRESIDENT
Credential: MD
Phone: 810-424-4761