Provider Demographics
NPI:1598845257
Name:RADIOLOGY SUB-SPECIALTY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:RADIOLOGY SUB-SPECIALTY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-9215
Mailing Address - Street 1:3152 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1220
Mailing Address - Country:US
Mailing Address - Phone:810-230-9215
Mailing Address - Fax:810-230-9225
Practice Address - Street 1:3152 CURTIS DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1220
Practice Address - Country:US
Practice Address - Phone:810-230-9215
Practice Address - Fax:810-230-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010506002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty