Healthcare Provider Details

I. General information

NPI: 1730049644
Provider Name (Legal Business Name): PRIME RADIOLOGY CONSULTANTS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

PO BOX 320007
FLINT MI
48532-0001
US

V. Phone/Fax

Practice location:
  • Phone: 810-354-7714
  • Fax:
Mailing address:
  • Phone: 810-354-7714
  • 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 Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TALAL KHOULANI
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 810-354-7714