Provider Demographics
NPI:1417252016
Name:MICHAEL LALA MD PC
Entity Type:Organization
Organization Name:MICHAEL LALA MD PC
Other - Org Name:SOUTH ALLEN RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-225-6909
Mailing Address - Street 1:3815 PINE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1650
Mailing Address - Country:US
Mailing Address - Phone:248-225-6909
Mailing Address - Fax:248-681-8589
Practice Address - Street 1:3815 PINE HARBOR DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1650
Practice Address - Country:US
Practice Address - Phone:248-225-6909
Practice Address - Fax:248-681-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010328402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3008214141OtherBCBS OF MICHIGAN
MI2106018Medicaid
MI0Q26214Medicare PIN
MI3008214141OtherBCBS OF MICHIGAN