Healthcare Provider Details

I. General information

NPI: 1003160755
Provider Name (Legal Business Name): UNITED DIAGNOSTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 STAR BATT DR
ROCHESTER HILLS MI
48309-3712
US

IV. Provider business mailing address

1901 STAR BATT DR SUITE 200
ROCHESTER HILLS MI
48309-3712
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-5690
  • Fax: 248-844-5691
Mailing address:
  • Phone: 248-844-5690
  • Fax: 248-844-5691

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: FARID FATA
Title or Position: SOLE MBR
Credential:
Phone: 248-844-5690