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General NPI Number Information
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NPI Number | 1821061938
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SONOCARDIOGRAPHIC IMAGING
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 04/23/2011
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Provider Practice Location Address
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Address Line | 1320 WILKINS ST
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City | DETROIT
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State | MI
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Zip | 48207-4802
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Country | US
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Telephone | 313-656-2151
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Fax | 313-656-2152
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Provider Business Mailing Address
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Address Line | 547 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48226-4324
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Country | US
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Telephone | 313-962-2133
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Fax | 313-962-2134
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | DR. VICTOR COLLADO
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Credential | M.D,. PH.D
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Telephone | 313-656-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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