Provider Demographics
NPI:1891164083
Name:GRAVITY IMAGING LLC
Entity Type:Organization
Organization Name:GRAVITY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-850-7888
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-0545
Mailing Address - Country:US
Mailing Address - Phone:313-850-7888
Mailing Address - Fax:
Practice Address - Street 1:1190 E 12 MILE RD STE 1
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2648
Practice Address - Country:US
Practice Address - Phone:313-850-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)