Healthcare Provider Details

I. General information

NPI: 1548461601
Provider Name (Legal Business Name): ULTRA-X IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W ANN ARBOR TRL
PLYMOUTH MI
48170-6225
US

IV. Provider business mailing address

729 W ANN ARBOR TRL
PLYMOUTH MI
48170-6225
US

V. Phone/Fax

Practice location:
  • Phone: 734-738-0030
  • Fax: 734-468-0488
Mailing address:
  • Phone: 734-738-0030
  • Fax: 734-468-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MEGAN BURNS
Title or Position: ADMIN DIRECTOR
Credential:
Phone: 734-738-0030