1558409649 NPI number — EASTPOINTE RADIOLOGISTS, PC

Table of content: (NPI 1558409649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558409649 NPI number — EASTPOINTE RADIOLOGISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTPOINTE RADIOLOGISTS, 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:
6
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:
1558409649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21003 MACK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE WOODS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-741-3772
Provider Business Mailing Address Fax Number:
586-741-4604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21003 MACK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROSSE POINTE WOODS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-881-0411
Provider Business Practice Location Address Fax Number:
313-881-3099
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMAME
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-741-3772

Provider Taxonomy Codes

  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0H26188 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0H26188 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 320433 . This is a "ULTICARE HMO OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 506044 . This is a "CARE CHOICES HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 300H261880 . This is a "BCN ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 495680 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C20438 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: SJ820005 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1111920004 . This is a "WELLNESS PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: SJ820005 . This is a "M-CARE SENIOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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