Provider Demographics
NPI:1316376858
Name:LAPEER MEDICAL DIAGNOSTICS PC
Entity Type:Organization
Organization Name:LAPEER MEDICAL DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIONTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-245-5562
Mailing Address - Street 1:944 BALDWIN RD
Mailing Address - Street 2:STE F
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3089
Mailing Address - Country:US
Mailing Address - Phone:810-245-7812
Mailing Address - Fax:810-245-7821
Practice Address - Street 1:944 BALDWIN RD
Practice Address - Street 2:STE F
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3089
Practice Address - Country:US
Practice Address - Phone:810-245-7812
Practice Address - Fax:810-245-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty