# GENESIS MD DIAGNOSTIC IMAGING PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336704311
- **Authorized official:** DR. EDRICK FERGUSON M.D. (OWNER)
- **Authorized official phone:** (313) 581-3255

## Contact information

- **Practice address:** 8560 N SILVERY LN STE 101, DEARBORN HEIGHTS, MI 48127-4516
- **Practice address phone:** (313) 581-3255
- **Practice address fax:** (313) 581-3755
- **Mailing address:** 8560 N SILVERY LN STE 101, DEARBORN HEIGHTS, MI 48127-4516
- **Mailing address phone:** (313) 581-3255
- **Mailing address fax:** (313) 581-3755

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0208X | Mobile Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/06/2019
- **Last updated:** 05/06/2019