Provider Demographics
NPI:1497923858
Name:MICHIGAN DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:MICHIGAN DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ATHEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-550-0111
Mailing Address - Street 1:6431 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1310
Mailing Address - Country:US
Mailing Address - Phone:248-550-0111
Mailing Address - Fax:248-550-0121
Practice Address - Street 1:6431 INKSTER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1310
Practice Address - Country:US
Practice Address - Phone:248-550-0111
Practice Address - Fax:248-550-0121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN DIAGNOSTIC SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00043OtherBCBSM
P00331281OtherRR MR
P00393162OtherRR MR
MI4468160Medicaid
P00135961OtherRR MR
0N57780Medicare PIN