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General NPI Number Information
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NPI Number | 1639196686
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Entity Type | Organization
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Legal Business Name | TAYLOR DIAGNOSTIC IMAGING INC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 28300 FRANKLIN RD STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1657
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Country | US
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Telephone | 248-347-0033
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Fax | 248-347-3003
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Provider Business Mailing Address
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Address Line | 28300 FRANKLIN RD STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1657
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Country | US
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Telephone | 248-347-0033
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Fax | 248-347-3003
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOMINIQUE BUCK
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Credential |
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Telephone | 248-347-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine 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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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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