Provider Demographics
NPI:1962458927
Name:AMD SOUTHFIELD MICHIGAN - LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:AMD SOUTHFIELD MICHIGAN - LIMITED PARTNERSHIP
Other - Org Name:MRI OF SOUTHFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:DIGIACOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-933-3344
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:STE L-11
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-354-5511
Mailing Address - Fax:248-356-3310
Practice Address - Street 1:29877 TELEGRAPH RD
Practice Address - Street 2:STE L-11
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1332
Practice Address - Country:US
Practice Address - Phone:248-354-5511
Practice Address - Fax:248-356-3310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMD SOUTHFIELD MICHIGAN - LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N40960Medicare PIN