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General NPI Number Information
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NPI Number | 1023187374
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Entity Type | Organization
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Legal Business Name | MCGH COMPREHENSIVE BREAST SCREENING CENTER LLC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 43900 GARFIELD RD SUITE 202
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1128
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Country | US
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Telephone | 586-412-5150
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Fax | 586-412-5165
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Provider Business Mailing Address
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Address Line | 43900 GARFIELD RD SUITE 202
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1128
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Country | US
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Telephone | 586-412-5150
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Fax | 586-412-5165
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Authorized Official
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Title or Position | VICE PRESIDENT OF TREASURY
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Name | MR. JOHN LISTON
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Credential |
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Telephone | 586-741-4156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | MI
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