Provider Demographics
NPI:1316265150
Name:MICHIGAN DIAGNOSTIC GROUP PLC
Entity type:Organization
Organization Name:MICHIGAN DIAGNOSTIC GROUP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:586-251-2095
Mailing Address - Street 1:41400 DEQUINDRE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3751
Mailing Address - Country:US
Mailing Address - Phone:586-843-3815
Mailing Address - Fax:586-843-3920
Practice Address - Street 1:41400 DEQUINDRE RD STE 121
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3751
Practice Address - Country:US
Practice Address - Phone:586-843-3815
Practice Address - Fax:586-843-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty