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General NPI Number Information
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NPI Number | 1831583228
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Entity Type | Organization
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Legal Business Name | SUPERIOR DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 24481 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2931
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Country | US
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Telephone | 248-939-8090
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Fax | 201-939-8091
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Provider Business Mailing Address
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Address Line | 24481 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2931
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Country | US
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Telephone | 248-939-8090
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Fax | 201-939-8091
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARK RADOM
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Credential |
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Telephone | 248-939-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | 63C073
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License Number State | MI
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