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General NPI Number Information
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NPI Number | 1932588738
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MICHIGAN RADIOLOGY, PLLC
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 3700 RIVERTOWN PKWY SW SUITE 1002
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City | GRANDVILLE
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State | MI
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Zip | 49418-3085
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Country | US
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Telephone | 616-548-5687
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Fax | 616-931-5686
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Provider Business Mailing Address
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Address Line | 3700 RIVERTOWN PKWY SW SUITE 1002
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City | GRANDVILLE
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State | MI
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Zip | 49418-3085
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Country | US
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Telephone | 616-548-5687
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Fax | 616-931-5686
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS BRUCE
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Credential | MD
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Telephone | 616-548-5687
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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 | MI
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State | MI
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