Provider Demographics
NPI:1811934771
Name:BRONSON SERVICES LLC
Entity type:Organization
Organization Name:BRONSON SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASLAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-363-7339
Mailing Address - Street 1:524 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5118
Mailing Address - Country:US
Mailing Address - Phone:269-381-2920
Mailing Address - Fax:269-381-4681
Practice Address - Street 1:524 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5118
Practice Address - Country:US
Practice Address - Phone:269-381-2920
Practice Address - Fax:269-381-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300C911710OtherBLUE CROSS BLUE SHIELD
MIDB9949OtherRAILROAD MEDICARE
MIP31729FOtherBLUE CARE NETWORK
MI0N80710Medicare PIN