Provider Demographics
NPI:1003857566
Name:SAVING GRACE DIAGNOSTIC INC
Entity Type:Organization
Organization Name:SAVING GRACE DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-855-6404
Mailing Address - Street 1:7092 HIGHLAND RD PMB153
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1502
Mailing Address - Country:US
Mailing Address - Phone:248-599-9491
Mailing Address - Fax:248-599-9492
Practice Address - Street 1:7092 HIGHLAND RD PMB 153
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-366-3277
Practice Address - Fax:248-366-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR070661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEIN