Provider Demographics
NPI:1225652993
Name:NORTHLAND RADIOLOGY INC.
Entity Type:Organization
Organization Name:NORTHLAND RADIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMEGOWDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-827-7200
Mailing Address - Street 1:26222 TELEGRAPH ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5318
Mailing Address - Country:US
Mailing Address - Phone:248-827-7200
Mailing Address - Fax:248-827-2641
Practice Address - Street 1:20905 GREENFIELD ROAD
Practice Address - Street 2:SUITE 406
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5344
Practice Address - Country:US
Practice Address - Phone:248-513-8229
Practice Address - Fax:248-479-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty