Healthcare Provider Details

I. General information

NPI: 1477646131
Provider Name (Legal Business Name): TRI-COUNTY IMAGING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26699 WEST TWELVE MILE ROAD SUITE 100
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

6691 BROOKESHIRE DR
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-225-4351
  • Fax:
Mailing address:
  • Phone: 248-668-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: SHIRIN MIKHALOV
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 248-225-4351