Provider Demographics
NPI:1326078668
Name:S E RADIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:S E RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-326-5030
Mailing Address - Street 1:4000 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1715
Mailing Address - Country:US
Mailing Address - Phone:734-326-5030
Mailing Address - Fax:
Practice Address - Street 1:33155 ANNAPOLIS WAY
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-326-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI008149OtherMIDWEST HEALTH PLAN
MI29711OtherCOMMUNITY CHOICE MI
MI3S27618OtherHEALTHPLUS OF MI
MI0H27893OtherBLUE CROSS BLUE SHIELD MI
MI0H27893OtherBLUE CARE NETWORK
MI2R27618OtherHEALTHPLUS OF MI
MI26538OtherFEDERAL BLACK LUNG
MI7668OtherPRIORITY HEALTH
MIO26194OtherHEALTH ALLIANCE PLAN
MI000000003836OtherCAPE HEALTH PLAN
MI107851OtherCARE CHOICES
MI107851OtherPREFERRED CHOICES
MICE4307OtherRAILROAD MEDICARE
MIRA820036OtherM-CARE
MI275144OtherFEDERAL BLACK LUNG
MIO26194OtherHEALTH ALLIANCE PLAN
MI3S27618OtherHEALTHPLUS OF MI