Healthcare Provider Details

I. General information

NPI: 1801603204
Provider Name (Legal Business Name): DIAGNOSTIC AND THERAPEUTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 06/16/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24555 HALLWOOD CT
FARMINGTON HILLS MI
48335-1667
US

IV. Provider business mailing address

24555 HALLWOOD CT
FARMINGTON HILLS MI
48335-1667
US

V. Phone/Fax

Practice location:
  • Phone: 888-405-5857
  • Fax:
Mailing address:
  • Phone: 888-405-5857
  • Fax:

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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BALDASSARE DANIEL PIPITONE
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 330-618-1458