Provider Demographics
NPI:1346216728
Name:X-RAY TREATMENT CENTER
Entity Type:Organization
Organization Name:X-RAY TREATMENT CENTER
Other - Org Name:X-RAY TREATMENT CENTER, PC/MCCI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIDEH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, JD
Authorized Official - Phone:248-338-0300
Mailing Address - Street 1:23337 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1642
Mailing Address - Country:US
Mailing Address - Phone:586-776-4820
Mailing Address - Fax:586-777-3239
Practice Address - Street 1:23337 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1642
Practice Address - Country:US
Practice Address - Phone:586-776-4820
Practice Address - Fax:586-777-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#