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General NPI Number Information
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NPI Number | 1538242581
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Entity Type | Organization
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Legal Business Name | IMAGE NORTH GAYLORD PC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2922 D AND M DR
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City | GAYLORD
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State | MI
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Zip | 49735-7417
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Country | US
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Telephone | 989-705-1100
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Fax | 989-705-1104
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Provider Business Mailing Address
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Address Line | 2922 D AND M DR
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City | GAYLORD
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State | MI
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Zip | 49735-7417
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Country | US
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Telephone | 989-705-1100
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Fax | 989-705-1104
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK J MCNAMARA
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Credential | DO
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Telephone | 989-705-1100
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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 | PM008127
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License Number State | MI
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