Provider Demographics
NPI:1093749616
Name:WARREN RADIOLOGY, PC
Entity Type:Organization
Organization Name:WARREN RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARBONIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-758-5030
Mailing Address - Street 1:27075 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4717
Mailing Address - Country:US
Mailing Address - Phone:586-758-5030
Mailing Address - Fax:586-758-7442
Practice Address - Street 1:27075 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4717
Practice Address - Country:US
Practice Address - Phone:586-758-5030
Practice Address - Fax:586-758-7442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHOENERR MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E001650OtherBLUE CROSS BLUE SHIELD MI
MI0P06950Medicare ID - Type Unspecified