Healthcare Provider Details

I. General information

NPI: 1922389832
Provider Name (Legal Business Name): ADVANCE DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 TELEGRAPH RD STE 203
TAYLOR MI
48180-6847
US

IV. Provider business mailing address

12701 TELEGRAPH RD STE 203
TAYLOR MI
48180-6847
US

V. Phone/Fax

Practice location:
  • Phone: 734-796-4042
  • Fax:
Mailing address:
  • Phone: 734-796-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS GHAZALA KHAN
Title or Position: BILLING MANAGER
Credential:
Phone: 734-693-4011