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General NPI Number Information
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NPI Number | 1972586717
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Entity Type | Organization
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Legal Business Name | GREAT LAKES MRI OF MICHIGAN LLC
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 27301 SCHOENHERR RD SUITE 100
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City | WARREN
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State | MI
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Zip | 48088-6649
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Country | US
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Telephone | 586-427-7226
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Fax | 586-427-4966
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Provider Business Mailing Address
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Address Line | 27301 SCHOENHERR RD SUITE 100
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City | WARREN
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State | MI
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Zip | 48088-6649
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Country | US
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Telephone | 586-427-7226
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DEL CHARBONIER
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Credential | M.D.
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Telephone | 586-427-7226
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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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