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General NPI Number Information
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NPI Number | 1770740581
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Entity Type | Organization
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Legal Business Name | MID-MICHIGAN RADIOLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 300 WARWICK
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City | ALMA
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State | MI
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Zip | 48801-1014
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Country | US
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Telephone | 989-466-3342
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Fax | 989-466-7250
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Provider Business Mailing Address
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Address Line | PO BOX 30516 DEPT 6086
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City | LANSING
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State | MI
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Zip | 48909-8016
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Country | US
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Telephone | 989-466-3342
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Fax | 989-466-7250
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHANNES BUITEWEG
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Credential | MD
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Telephone | 989-773-2018
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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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