Provider Demographics
NPI:1881683118
Name:SOUTHWEST MICHIGAN IMAGING CENTER LLC
Entity Type:Organization
Organization Name:SOUTHWEST MICHIGAN IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AZZAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-342-1099
Mailing Address - Street 1:1700 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1610
Mailing Address - Country:US
Mailing Address - Phone:269-342-1099
Mailing Address - Fax:
Practice Address - Street 1:1700 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1610
Practice Address - Country:US
Practice Address - Phone:269-342-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)