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General NPI Number Information
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NPI Number | 1871525915
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Entity Type | Organization
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Legal Business Name | SOUTHFIELD RADIOLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 23100 PROVIDENCE DR SUITE 420
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3646
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Country | US
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Telephone | 248-569-4353
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Fax | 248-569-5227
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Provider Business Mailing Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-569-4353
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Fax | 248-569-5227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDSA NEGUSSIE
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Credential | MD
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Telephone | 248-308-2745
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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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