Provider Demographics
NPI:1780122804
Name:CRYSTAL CLEAR HEALTH MANAGEMENT INC
Entity type:Organization
Organization Name:CRYSTAL CLEAR HEALTH MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ARAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-557-7302
Mailing Address - Street 1:16100 19 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1148
Mailing Address - Country:US
Mailing Address - Phone:586-932-6303
Mailing Address - Fax:586-932-6304
Practice Address - Street 1:16100 19 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1148
Practice Address - Country:US
Practice Address - Phone:586-932-6303
Practice Address - Fax:586-932-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)