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General NPI Number Information
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NPI Number | 1174621783
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Entity Type | Organization
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Legal Business Name | ADVANCED IMAGING OF MICHIGAN
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7092 HIGHLAND RD PMB 205
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City | WATERFORD
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State | MI
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Zip | 48327-1502
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Country | US
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Telephone | 248-889-9282
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Fax | 248-889-7534
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Provider Business Mailing Address
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Address Line | 7092 HIGHLAND RD PMB 205
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City | WATERFORD
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State | MI
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Zip | 48327-1502
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Country | US
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Telephone | 248-889-9282
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Fax | 248-889-7534
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | DR. ROGER FENTON
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Credential | MD
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Telephone | 248-889-9282
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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 | RF006368
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License Number State | MI
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