Healthcare Provider Details

I. General information

NPI: 1972711554
Provider Name (Legal Business Name): MED-SCAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26222 TELEGRAPH RD SUITE 100
SOUTHFIELD MI
48034-5318
US

IV. Provider business mailing address

26222 TELEGRAPH RD SUITE 100
SOUTHFIELD MI
48034-5318
US

V. Phone/Fax

Practice location:
  • Phone: 248-827-7200
  • Fax: 248-827-2641
Mailing address:
  • Phone: 248-827-7200
  • Fax: 248-827-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PRAKASH GANDHI
Title or Position: PRESIDENT
Credential:
Phone: 248-827-7200