Provider Demographics
NPI:1912528456
Name:QUANTUM DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:QUANTUM DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:MOUSSA
Authorized Official - Last Name:AWADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-9333
Mailing Address - Street 1:23337 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3238
Mailing Address - Country:US
Mailing Address - Phone:248-598-7474
Mailing Address - Fax:
Practice Address - Street 1:23337 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3238
Practice Address - Country:US
Practice Address - Phone:248-598-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)