Provider Demographics
NPI:1417960139
Name:S.E. MICHIGAN DIAGNOSTIC CENTER PC
Entity Type:Organization
Organization Name:S.E. MICHIGAN DIAGNOSTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-399-3550
Mailing Address - Street 1:31800 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1655
Mailing Address - Country:US
Mailing Address - Phone:248-626-0766
Mailing Address - Fax:248-626-7498
Practice Address - Street 1:350 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2531
Practice Address - Country:US
Practice Address - Phone:248-545-3754
Practice Address - Fax:248-399-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty