Provider Demographics
NPI:1982997078
Name:AFFILIATED DIAGNOSTIC OF OAKLAND LLC
Entity Type:Organization
Organization Name:AFFILIATED DIAGNOSTIC OF OAKLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-562-6607
Mailing Address - Street 1:26550 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3741
Mailing Address - Country:US
Mailing Address - Phone:248-809-3350
Mailing Address - Fax:248-809-3531
Practice Address - Street 1:26550 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3741
Practice Address - Country:US
Practice Address - Phone:248-809-3350
Practice Address - Fax:248-809-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036838261QM1200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherCOMMERCIAL