Provider Demographics
NPI:1639196686
Name:TAYLOR DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:TAYLOR DIAGNOSTIC IMAGING INC
Other - Org Name:DIAGNOSTICS IMAGING INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-347-0033
Mailing Address - Street 1:28300 FRANKLIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1657
Mailing Address - Country:US
Mailing Address - Phone:248-347-0033
Mailing Address - Fax:248-347-3003
Practice Address - Street 1:28300 FRANKLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1657
Practice Address - Country:US
Practice Address - Phone:248-347-0033
Practice Address - Fax:248-347-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H23135OtherBCBSM
MIDB1714OtherPALMETTO GBA MEDICARE
0H23135OtherBCBSM