Healthcare Provider Details

I. General information

NPI: 1801967583
Provider Name (Legal Business Name): X-RAY ASSOCIATES OF PORT HURON P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 PINE GROVE AVE STE 7
PORT HURON MI
48060
US

IV. Provider business mailing address

1530 PINE GROVE AVE STE 7
PORT HURON MI
48060
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-0029
  • Fax: 810-985-0032
Mailing address:
  • Phone: 810-985-0029
  • Fax: 810-985-0032

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: DANIEL SHOGREN
Title or Position: PRESIDENT
Credential: MD
Phone: 810-987-5000