1841444007 NPI number — MICHIGAN INTERVENTIONAL RADIOLOGY ASSOCIATES, PC

Table of content: (NPI 1841444007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841444007 NPI number — MICHIGAN INTERVENTIONAL RADIOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN INTERVENTIONAL RADIOLOGY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841444007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8367 MISTY MDWS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-7427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-953-3060
Provider Business Mailing Address Fax Number:
810-953-3093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2370 S LINDEN RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-5429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-230-9833
Provider Business Practice Location Address Fax Number:
810-715-9649
Provider Enumeration Date:
11/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAO
Authorized Official First Name:
VIKRAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-230-9833

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301067627 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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