Provider Demographics
NPI:1891230900
Name:MICHIGAN RADIOLOGY INSTITUTE PLLC
Entity Type:Organization
Organization Name:MICHIGAN RADIOLOGY INSTITUTE PLLC
Other - Org Name:M1 IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHINTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-268-2119
Mailing Address - Street 1:27501 WOODWARD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0904
Mailing Address - Country:US
Mailing Address - Phone:248-268-2119
Mailing Address - Fax:248-268-2164
Practice Address - Street 1:27501 WOODWARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0904
Practice Address - Country:US
Practice Address - Phone:248-268-2119
Practice Address - Fax:248-268-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty