Provider Demographics
NPI:1104158930
Name:COMPREHENSIVE DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:COMPREHENSIVE DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUNAWAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-748-2292
Mailing Address - Street 1:23300 GREENFIELD RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5237
Mailing Address - Country:US
Mailing Address - Phone:734-748-2292
Mailing Address - Fax:734-451-0603
Practice Address - Street 1:23300 GREENFIELD RD
Practice Address - Street 2:SUITE 219
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-5237
Practice Address - Country:US
Practice Address - Phone:734-748-2292
Practice Address - Fax:734-451-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN