Provider Demographics
NPI:1013930460
Name:UNITED EAGLE IMAGING, LLC
Entity Type:Organization
Organization Name:UNITED EAGLE IMAGING, LLC
Other - Org Name:CLARKSTON MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-625-7506
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:STE 107
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-625-7506
Mailing Address - Fax:248-625-7884
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:STE 107
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-625-7506
Practice Address - Fax:248-625-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N89620Medicare ID - Type Unspecified