MEDICARE: MICHIGAN DIAGNOSTIC SERVICES, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2471C3402X	Radiography Radiologic Technologist
2	2471S1302X	Sonography Radiologic Technologist
3	2471V0105X	Vascular Sonography Radiologic Technologist
4	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0E00043	OTHER	MI	BCBSM
2	P00331281	OTHER		RR MR
3	P00393162	OTHER		RR MR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P00135961	OTHER		RR MR

General Provider Information

NPI Number	:	1811935315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN DIAGNOSTIC SERVICES, INC

Provider Business Mailing Address
First Line	:	6431 INKSTER RD
Second Line	:	STE 120
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-1310
Country	:	US
Telephone Number	:	248-550-0111
Fax Number	:	248-550-0121

Provider Business Practice Location Address
First Line	:	6431 INKSTER RD
Second Line	:	STE 120
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-1310
Country	:	US
Telephone Number	:	248-550-0111
Fax Number	:	248-550-0121

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. ATHEIR AMARRAH
Credential	:
Telephone Number	:	248-550-0111

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/19/2016

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