Provider Demographics
NPI:1881836435
Name:OPDYKE DIAGNOSTIC CENTER PLC
Entity type:Organization
Organization Name:OPDYKE DIAGNOSTIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KULICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-333-2600
Mailing Address - Street 1:719 S OPDYKE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3436
Mailing Address - Country:US
Mailing Address - Phone:248-874-4908
Mailing Address - Fax:248-874-4370
Practice Address - Street 1:10740 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-1123
Practice Address - Country:US
Practice Address - Phone:248-625-7007
Practice Address - Fax:248-625-0314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPDYKE DIAGNOSTIC CENTER PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F339930OtherBCBSM
MI0P52760Medicare PIN