Provider Demographics
NPI:1306358478
Name:METRO HEALTHCARE IMAGING, PLLC
Entity Type:Organization
Organization Name:METRO HEALTHCARE IMAGING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:NAKISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-363-3304
Mailing Address - Street 1:7010 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2017
Mailing Address - Country:US
Mailing Address - Phone:248-363-3304
Mailing Address - Fax:
Practice Address - Street 1:7010 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2017
Practice Address - Country:US
Practice Address - Phone:248-363-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT G. NAKISHER, D.D.S., P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology