Provider Demographics
NPI:1407129133
Name:MICHIGAN RADIOLOGY PC
Entity Type:Organization
Organization Name:MICHIGAN RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-891-1336
Mailing Address - Street 1:3805 E BELL RD
Mailing Address - Street 2:STE 5500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2189
Mailing Address - Country:US
Mailing Address - Phone:866-891-1336
Mailing Address - Fax:
Practice Address - Street 1:3805 E BELL RD
Practice Address - Street 2:STE 5500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2189
Practice Address - Country:US
Practice Address - Phone:866-891-1336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty