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General NPI Number Information
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NPI Number | 1679984322
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Entity Type | Organization
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Legal Business Name | MICHIGAN RADIATION MEDICINE PLLC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 315 E WARWICK DR STE C
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City | ALMA
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State | MI
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Zip | 48801-1083
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Country | US
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Telephone | 989-463-9300
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Fax | 989-463-9305
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Provider Business Mailing Address
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Address Line | 4440 GLADDING CT
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City | MIDLAND
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State | MI
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Zip | 48640-3320
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Country | US
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Telephone | 989-486-3522
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Fax | 989-463-9305
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Authorized Official
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Title or Position | OWNER
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Name | MARK FIREMAN
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Credential | MD
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Telephone | 989-463-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 4301067042
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License Number State | MI
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