Provider Demographics
NPI:1891097853
Name:SHELBY-MACOMB DIAGNOSTIC CENTER, PLC
Entity Type:Organization
Organization Name:SHELBY-MACOMB DIAGNOSTIC CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF SHELBY MACOMB DIAG CTR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:586-726-5566
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-726-5566
Mailing Address - Fax:586-726-8085
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 010
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-731-5849
Practice Address - Fax:586-731-5862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED INTERNISTS OF MACOMB, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty