Provider Demographics
NPI:1568656932
Name:CEDAR STRAITS MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CEDAR STRAITS MEDICAL ASSOCIATES PC
Other - Org Name:CEDAR STRAITS RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-677-7400
Mailing Address - Street 1:PO BOX 3079
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1822
Practice Address - Country:US
Practice Address - Phone:800-764-7297
Practice Address - Fax:734-677-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4756620Medicaid
MI0A710590OtherBCBS OF MI GROUP PIN
MIDD4837OtherPALMETTO GBA/MEDICARE RR
MIDD4837OtherPALMETTO GBA/MEDICARE RR