Provider Demographics
NPI:1710008511
Name:IMAGE MEDICAL PC
Entity Type:Organization
Organization Name:IMAGE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-442-9320
Mailing Address - Street 1:28479 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3501
Mailing Address - Country:US
Mailing Address - Phone:248-442-9320
Mailing Address - Fax:248-442-8840
Practice Address - Street 1:28479 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3501
Practice Address - Country:US
Practice Address - Phone:248-442-9320
Practice Address - Fax:248-442-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty