Provider Demographics
NPI:1841522141
Name:MICHIGAN VISITING PHYSICIANS
Entity type:Organization
Organization Name:MICHIGAN VISITING PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNABALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-279-9850
Mailing Address - Street 1:6240 RASHELLE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6240 RASHELLE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3934
Practice Address - Country:US
Practice Address - Phone:586-279-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI429780247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty