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NPI Code Detail

MEDICARE: NORTHERN IMAGING ASSOCIATES P C

MEDICARE: NORTHERN IMAGING ASSOCIATES P C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CN8601OTHERMIMEDICARE RR GROUP PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300B410050OTHERMIBCBS
3P103164OTHERMIBCBS

General Provider Information

NPI Number : 1801895412
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN IMAGING ASSOCIATES P C
Provider Business Mailing Address
First Line : PO BOX 5617
Second Line :
City : SAGINAW
State : MI
Zip : 48603-0617
Country : US
Telephone Number : 810-625-4222
Fax Number :
Provider Business Practice Location Address
First Line : 416 CONNABLE AVE
Second Line :
City : PETOSKEY
State : MI
Zip : 49770-2212
Country : US
Telephone Number : 810-625-4222
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MICHAEL ANGILERI
Credential : MD
Telephone Number : 810-625-4222
Provider Enumeration Date : 07/15/2005
Last Update Date : 07/21/2022

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Directions to “NORTHERN IMAGING ASSOCIATES P C ” Practice Location

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