| NPI | 1134982812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY GUNTER RUSSIAN Supervisor, Provider Enrollment 517-253-6308 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0200X Clinic/Center Radiology |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound |
| 2085B0100X Radiology Body Imaging | |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-03-26 |