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General NPI Number Information
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NPI Number | 1144543562
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Entity Type | Organization
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Legal Business Name | ENVISION DIAGNOSTIC CENTER PLLC
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 39475 LEWIS DR STE 200
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City | NOVI
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State | MI
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Zip | 48377-2980
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Country | US
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Telephone | 248-715-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 39475 LEWIS DR STE 200
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City | NOVI
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State | MI
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Zip | 48377-2980
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Country | US
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Telephone | 248-471-0675
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Fax | 248-254-3874
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANTHONY MUNACO
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Credential | MD
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Telephone | 248-476-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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