Provider Demographics
NPI:1386972602
Name:AM DIAGNOSTICS
Entity type:Organization
Organization Name:AM DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ATHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-405-9423
Mailing Address - Street 1:17520 W 12 MILE ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1945
Mailing Address - Country:US
Mailing Address - Phone:586-405-9423
Mailing Address - Fax:248-557-4604
Practice Address - Street 1:17520 W 12 MILE ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1945
Practice Address - Country:US
Practice Address - Phone:586-405-9423
Practice Address - Fax:248-557-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier