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General NPI Number Information
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NPI Number | 1811214265
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Entity Type | Organization
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Legal Business Name | MICHIGAN TELERAD LLC
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 45765 TOURNAMENT DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-8581
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Country | US
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Telephone | 248-767-4579
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Fax | 214-712-2487
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD SUITE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone | 214-712-2074
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Fax | 214-712-2487
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP TEMPLETON
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Credential | MD
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Telephone | 214-712-2074
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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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