Provider Demographics
NPI:1477578144
Name:DIAGNOSTIC RADIOLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ZESKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-573-5060
Mailing Address - Street 1:11800 E TWELVE MILE ROAD
Mailing Address - Street 2:DIAGNOSTIC RADIOLOGY CONSULTANTS
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-573-5060
Mailing Address - Fax:586-573-5197
Practice Address - Street 1:11800 E TWELVE MILE ROAD
Practice Address - Street 2:ST JOHN MACOMB HOSPITAL
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-573-5060
Practice Address - Fax:586-573-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E076035Medicare ID - Type Unspecified