Provider Demographics
NPI:1659703304
Name:TESLA IMAGING AND MEDICAL
Entity Type:Organization
Organization Name:TESLA IMAGING AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-501-0523
Mailing Address - Street 1:43817 NTH 50TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85087
Mailing Address - Country:US
Mailing Address - Phone:602-501-0523
Mailing Address - Fax:623-572-9539
Practice Address - Street 1:43817 NTH 50TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85087
Practice Address - Country:US
Practice Address - Phone:602-501-0523
Practice Address - Fax:623-572-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty