Healthcare Provider Details
I. General information
NPI: 1033384490
Provider Name (Legal Business Name): OMG#1PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/28/2008
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
27483 DEQUINDRE RD STE 101
MADISON HEIGHTS MI
48071-5700
US
IV. Provider business mailing address
29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS MI
48334-3292
US
V. Phone/Fax
- Phone: 248-544-9050
- Fax: 248-544-2331
- Phone: 248-851-1430
- Fax: 248-851-5319
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085U0001X |
| Taxonomy | Diagnostic Ultrasound Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RC0000X |
| Taxonomy | Cardiovascular Disease Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208100000X |
| Taxonomy | Physical Medicine & Rehabilitation Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0204X |
| Taxonomy | Vascular & Interventional Radiology Physician |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RM1200X |
| Taxonomy | Magnetic Resonance Imaging (MRI) Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RP1001X |
| Taxonomy | Pulmonary Disease Physician |
| License Number | |
| License Number State | |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207U00000X |
| Taxonomy | Nuclear Medicine Physician |
| License Number | |
| License Number State | |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
HAROLD
MARGOLIS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 248-851-1430