Provider Demographics
NPI:1730479114
Name:ULTRASOUND ASSOCIATES OF MICHIGAN LLC
Entity Type:Organization
Organization Name:ULTRASOUND ASSOCIATES OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:OTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:754-264-3308
Mailing Address - Street 1:123 S MAIN ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2631
Mailing Address - Country:US
Mailing Address - Phone:754-264-3308
Mailing Address - Fax:
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2631
Practice Address - Country:US
Practice Address - Phone:754-264-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center