Provider Demographics
NPI:1831583228
Name:SUPERIOR DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:SUPERIOR DIAGNOSTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-939-8090
Mailing Address - Street 1:24481 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2931
Mailing Address - Country:US
Mailing Address - Phone:248-939-8090
Mailing Address - Fax:201-939-8091
Practice Address - Street 1:24481 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2931
Practice Address - Country:US
Practice Address - Phone:248-939-8090
Practice Address - Fax:201-939-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63C073261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)