Provider Demographics
NPI:1215942966
Name:MICHIGAN RADIOLOGY CONSULTANTS, PC
Entity type:Organization
Organization Name:MICHIGAN RADIOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-772-6734
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:ATTN: LYNDA THOMPSON
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1108
Mailing Address - Country:US
Mailing Address - Phone:734-677-7400
Mailing Address - Fax:734-677-7407
Practice Address - Street 1:1221 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3258
Practice Address - Country:US
Practice Address - Phone:989-772-6734
Practice Address - Fax:989-772-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDC7886OtherRR MEDICARE
MI0M05480Medicare ID - Type UnspecifiedGROUP #