Provider Demographics
NPI:1194191700
Name:SOUTHEAST MICHIGAN IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:SOUTHEAST MICHIGAN IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-427-8660
Mailing Address - Street 1:15201 CENTURY DR
Mailing Address - Street 2:SUITE 606
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1232
Mailing Address - Country:US
Mailing Address - Phone:313-427-8660
Mailing Address - Fax:313-427-8667
Practice Address - Street 1:15201 CENTURY DR
Practice Address - Street 2:SUITE 606
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1232
Practice Address - Country:US
Practice Address - Phone:313-427-8660
Practice Address - Fax:313-427-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty