Provider Demographics
NPI:1801967583
Name:X-RAY ASSOCIATES OF PORT HURON P C
Entity type:Organization
Organization Name:X-RAY ASSOCIATES OF PORT HURON P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-987-5000
Mailing Address - Street 1:1530 PINE GROVE AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-985-0029
Mailing Address - Fax:810-985-0032
Practice Address - Street 1:1530 PINE GROVE AVE
Practice Address - Street 2:STE 7
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-0029
Practice Address - Fax:810-985-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G47607Medicare ID - Type Unspecified