Provider Demographics
NPI:1861445439
Name:PORTABLE DIAGNOSTIC ULTRASOUND IMAGING, INC.
Entity Type:Organization
Organization Name:PORTABLE DIAGNOSTIC ULTRASOUND IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELEONORA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RCS
Authorized Official - Phone:248-872-6262
Mailing Address - Street 1:5584 PEMBURY
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4011
Mailing Address - Country:US
Mailing Address - Phone:248-872-6262
Mailing Address - Fax:248-671-5363
Practice Address - Street 1:21751 W 11 MILE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3712
Practice Address - Country:US
Practice Address - Phone:248-872-6262
Practice Address - Fax:248-671-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0000010812246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty