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General NPI Number Information
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NPI Number | 1164601035
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Entity Type | Organization
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Legal Business Name | GI DIAGNOSTIC CENTER WATERFORD
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 4000 HIGHLAND RD SUITE 100
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City | WATERFORD
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State | MI
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Zip | 48328-2167
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Country | US
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Telephone | 248-682-4900
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Fax | 248-682-4909
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Provider Business Mailing Address
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Address Line | 4000 HIGHLAND RD SUITE 100
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City | WATERFORD
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State | MI
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Zip | 48328-2167
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Country | US
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Telephone | 248-682-4900
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Fax | 248-682-4909
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAFIUL HASAN
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Credential | M.D.
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Telephone | 248-682-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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