Healthcare Provider Details

I. General information

NPI: 1598037061
Provider Name (Legal Business Name): GLOBAL VERSA RADIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 AUTO CLUB DR
DEARBORN MI
48126-2683
US

IV. Provider business mailing address

5500 AUTO CLUB DR
DEARBORN MI
48126-2683
US

V. Phone/Fax

Practice location:
  • Phone: 877-682-9968
  • Fax:
Mailing address:
  • Phone: 877-682-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301099836
License Number StateMI

VIII. Authorized Official

Name: EYAL MORAG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 877-682-9968