Provider Demographics
NPI:1043255581
Name:S. E. MICHIGAN DIAGNOSTIC CENTER PC
Entity Type:Organization
Organization Name:S. E. MICHIGAN DIAGNOSTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-399-3550
Mailing Address - Street 1:350 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2531
Mailing Address - Country:US
Mailing Address - Phone:248-545-3754
Mailing Address - Fax:248-545-4027
Practice Address - Street 1:350 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2531
Practice Address - Country:US
Practice Address - Phone:248-545-3754
Practice Address - Fax:248-545-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376540286OtherNPI # KACHADURIAN
MI1205824505OtherNPI # RUBIN
MI1346212800OtherNPI BORIN
MI1891751509OtherNPI KOVAN
MI1063490894OtherNPI # GOLDSTEIN
MI1588661391OtherNPI # ELKISS
MI1437181146OtherNPI # MELLEN
MIDE3703OtherRAILROAD MEDICARE
MI1588661391OtherNPI # ELKISS