Provider Demographics
NPI:1891882023
Name:MEDICAL DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORDELOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-788-4105
Mailing Address - Street 1:33597 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2239
Mailing Address - Country:US
Mailing Address - Phone:248-788-4105
Mailing Address - Fax:248-788-4119
Practice Address - Street 1:33597 WALNUT LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-2239
Practice Address - Country:US
Practice Address - Phone:248-788-4105
Practice Address - Fax:248-788-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4979750Medicaid
MI540F335660OtherBCBS
MI540F335660OtherBCBS