Healthcare Provider Details

I. General information

NPI: 1104738491
Provider Name (Legal Business Name): CUC INTERVENTIONAL RADIOLOGY MICHIGAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32743 23 MILE RD STE 130
CHESTERFIELD MI
48047-2082
US

IV. Provider business mailing address

32743 23 MILE RD STE 130
CHESTERFIELD MI
48047-2082
US

V. Phone/Fax

Practice location:
  • Phone: 516-689-4446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEVICA PITTIMAN-BARRERA
Title or Position: HEAD OF RCM
Credential:
Phone: 516-689-4446