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General NPI Number Information
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NPI Number | 1285050641
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Entity Type | Organization
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Legal Business Name | MICHIGAN INSTITUTE OF VASCULAR AND INTERVENTIONAL RADIOLOGY, PLLC
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 23800 FORD RD
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3200
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Country | US
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Telephone | 313-274-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 1756 KINMORE ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALI N HARB
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Credential | MD
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Telephone | 313-580-9858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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