Provider Demographics
NPI:1598139511
Name:NORTHERN LIGHTS RADIOLOGY P C
Entity Type:Organization
Organization Name:NORTHERN LIGHTS RADIOLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIAGNOSTIC RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FLESZAR
Authorized Official - Suffix:I
Authorized Official - Credentials:DO
Authorized Official - Phone:941-302-6016
Mailing Address - Street 1:8604 LYMAN RD
Mailing Address - Street 2:
Mailing Address - City:KALEVA
Mailing Address - State:MI
Mailing Address - Zip Code:49645-9717
Mailing Address - Country:US
Mailing Address - Phone:941-302-6016
Mailing Address - Fax:
Practice Address - Street 1:1465 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9709
Practice Address - Country:US
Practice Address - Phone:941-302-6016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010099672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty