| NPI | 1457586083 |
|---|---|
| Former Legal Business Name | GREAT LAKES TELERADIOLOGY VENTURES PLLC |
| Entity Type | Organization |
| Authorized Contact | AMY SAAD Credentialer 313-655-4544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 193400000X) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2014-07-30 |