Healthcare Provider Details

I. General information

NPI: 1326246182
Provider Name (Legal Business Name): PSI RADIOLOGICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W GRAND BLVD
DETROIT MI
48216-2200
US

IV. Provider business mailing address

547 E JEFFERSON AVE
DETROIT MI
48226-4324
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-3310
  • Fax: 313-841-6513
Mailing address:
  • Phone: 313-962-2133
  • Fax: 313-962-2134

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
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR COLLADO
Title or Position: RADIOLOGIST
Credential: M.D., PHD
Phone: 810-333-8026