Healthcare Provider Details

I. General information

NPI: 1942438122
Provider Name (Legal Business Name): FRG MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 E OUTER DR
DETROIT MI
48234-3241
US

IV. Provider business mailing address

PO BOX 60
PITTSBURGH PA
15230-0060
US

V. Phone/Fax

Practice location:
  • Phone: 313-369-5800
  • Fax:
Mailing address:
  • Phone: 412-937-5726
  • Fax: 412-937-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM PISULA
Title or Position: COO
Credential:
Phone: 412-551-0011