Provider Demographics
NPI:1760638241
Name:MID MICHIGAN DIAGNOSTIC CORP
Entity Type:Organization
Organization Name:MID MICHIGAN DIAGNOSTIC CORP
Other - Org Name:MID MICHIGAN DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZAKWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUDANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-742-8770
Mailing Address - Street 1:1513 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1728
Mailing Address - Country:US
Mailing Address - Phone:810-742-8770
Mailing Address - Fax:810-742-8772
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3043
Practice Address - Country:US
Practice Address - Phone:810-742-8770
Practice Address - Fax:810-742-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty