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General NPI Number Information
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NPI Number | 1760638241
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Entity Type | Organization
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Legal Business Name | MID MICHIGAN DIAGNOSTIC CORP
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 3400 FLECKENSTEIN RD SUITE D
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City | FLINT
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State | MI
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Zip | 48507-3043
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Country | US
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Telephone | 810-742-8770
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Fax | 810-742-8772
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Provider Business Mailing Address
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Address Line | 1513 S CENTER RD
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City | BURTON
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State | MI
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Zip | 48509-1728
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Country | US
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Telephone | 810-742-8770
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Fax | 810-742-8772
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Authorized Official
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Title or Position | OWNER
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Name | MR. ZAKWAN ABOUDANE
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Credential |
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Telephone | 810-742-8770
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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 |
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License Number State |
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