Healthcare Provider Details

I. General information

NPI: 1275637704
Provider Name (Legal Business Name): OAKLAND DIAGNOSTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19189 W 10 MILE ROAD SUITE 100
SOUTHFIELD MI
48075
US

IV. Provider business mailing address

19189 W 10 MILE ROAD SUITE 100
SOUTHFIELD MI
48075
US

V. Phone/Fax

Practice location:
  • Phone: 248-356-4749
  • Fax: 248-948-9031
Mailing address:
  • Phone: 248-356-4749
  • Fax: 248-948-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ELOISA ORIAL
Title or Position: PRESIDENT
Credential:
Phone: 248-356-4749