Healthcare Provider Details

I. General information

NPI: 1881683118
Provider Name (Legal Business Name): SOUTHWEST MICHIGAN IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 GULL RD
KALAMAZOO MI
49048-1610
US

IV. Provider business mailing address

1700 GULL RD
KALAMAZOO MI
49048-1610
US

V. Phone/Fax

Practice location:
  • Phone: 269-342-1099
  • Fax:
Mailing address:
  • Phone: 269-342-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AZZAM S KANAAN
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 269-342-1099