Healthcare Provider Details

I. General information

NPI: 1598845257
Provider Name (Legal Business Name): RADIOLOGY SUB-SPECIALTY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 CURTIS DR
FLINT MI
48507-1220
US

IV. Provider business mailing address

3152 CURTIS DR
FLINT MI
48507-1220
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-9215
  • Fax: 810-230-9225
Mailing address:
  • Phone: 810-230-9215
  • Fax: 810-230-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301050600
License Number StateMI

VIII. Authorized Official

Name: MARK WEISS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 810-230-9215