Provider Demographics
NPI:1265030068
Name:NOVELLO IMAGING PLC
Entity Type:Organization
Organization Name:NOVELLO IMAGING PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-444-0167
Mailing Address - Street 1:4290 COPPER RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7256
Mailing Address - Country:US
Mailing Address - Phone:314-218-5052
Mailing Address - Fax:231-421-8506
Practice Address - Street 1:4290 COPPER RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7256
Practice Address - Country:US
Practice Address - Phone:231-714-4306
Practice Address - Fax:231-714-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty