Provider Demographics
NPI:1245299494
Name:ADVANCED DIAGNOSTIC IMAGING PC
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKRISHNAYYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADAM
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:989-753-9000
Mailing Address - Street 1:3400 N CENTER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7920
Mailing Address - Country:US
Mailing Address - Phone:989-753-9000
Mailing Address - Fax:989-753-4024
Practice Address - Street 1:3400 N CENTER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7920
Practice Address - Country:US
Practice Address - Phone:989-753-9000
Practice Address - Fax:989-753-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0204X, 2085U0001X, 2085R0202X
MI5601004459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G36004Medicare PIN
MI0P14960Medicare PIN