Healthcare Provider Details

I. General information

NPI: 1003853144
Provider Name (Legal Business Name): MVP IMAGING PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 CHARLEVOIX AVE
PETOSKEY MI
49770-9701
US

IV. Provider business mailing address

1114 CHARLEVOIX AVE
PETOSKEY MI
49770-9701
US

V. Phone/Fax

Practice location:
  • Phone: 231-439-9700
  • Fax: 231-439-9709
Mailing address:
  • Phone: 231-439-9700
  • Fax: 231-439-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW VISCONTI
Title or Position: OWNER
Credential: M.D.
Phone: 231-439-9700