Healthcare Provider Details

I. General information

NPI: 1124264338
Provider Name (Legal Business Name): WARREN RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27075 SCHOENHERR RD
WARREN MI
48088-4717
US

IV. Provider business mailing address

27075 SCHOENHERR RD
WARREN MI
48088-4717
US

V. Phone/Fax

Practice location:
  • Phone: 586-758-5030
  • Fax:
Mailing address:
  • Phone: 586-758-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEL CHARBONIER
Title or Position: SUPERVISING PHYSICIAN
Credential: MD
Phone: 586-758-5030