Provider Demographics
NPI:1285050641
Name:MICHIGAN INSTITUTE OF VASCULAR AND INTERVENTIONAL RADIOLOGY, PLLC
Entity type:Organization
Organization Name:MICHIGAN INSTITUTE OF VASCULAR AND INTERVENTIONAL RADIOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-580-9858
Mailing Address - Street 1:1756 KINMORE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23800 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3200
Practice Address - Country:US
Practice Address - Phone:313-274-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty