Provider Demographics
NPI:1114263563
Name:MICHIGAN RADIATION INSTITUTE LLC
Entity Type:Organization
Organization Name:MICHIGAN RADIATION INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:URMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:YADAV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-868-2060
Mailing Address - Street 1:12801 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3413
Mailing Address - Country:US
Mailing Address - Phone:917-868-2060
Mailing Address - Fax:
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:MICHIGAN RADIATION ONCOLOGY, LLC
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:917-868-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty