Provider Demographics
NPI:1619089661
Name:MICHIGAN IMAGING GROUP, P.C.
Entity Type:Organization
Organization Name:MICHIGAN IMAGING GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-323-0400
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48311-0727
Mailing Address - Country:US
Mailing Address - Phone:586-991-0883
Mailing Address - Fax:586-991-0886
Practice Address - Street 1:38600 VAN DYKE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1170
Practice Address - Country:US
Practice Address - Phone:586-323-0400
Practice Address - Fax:586-323-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012490OtherBC
MI0N31900Medicare PIN