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Organization
FARMBROOK RADIOLOGY ASSOCIATES PC
Active
Organization
FARMBROOK RADIOLOGY ASSOCIATES PC
Active
Other names
Farmbrook Radiology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
VICKY ROURKE (CREDENTIALING BILLING)
(248) 352-9525
Entity
Organization
Contact information
Practice address
29829 TELEGRAPH RD, SUITE L103, SOUTHFIELD, MI 48034-1376
(248) 352-9525
(248) 357-2959
Mailing address
29829 TELEGRAPH RD, SUITE L103, SOUTHFIELD, MI 48034-1376
(248) 352-9525
(248) 357-2959
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
00
MI
2085R0202X
Diagnostic Radiology Physician
00
MI
2085R0204X
Vascular & Interventional Radiology Physician
00
MI
2085U0001X
Diagnostic Ultrasound Physician
Primary
00
MI
261QR0206X
Mammography Clinic/Center
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007775-001
WELLNESS PLAN GROUP PIN
MI
01
—
132484
GREAT LAKE HEALTH PLAN
MI
01
—
5006540
AETNA GROUP PIN
MI
01
—
506377
CARE CHOICES GROUP PIN
MI
01
—
5101
CAPE HEALTH PLAN GROUP
MI
01
—
OF372090
BLUE SHIELD GROUP PIN
MI
01
—
QMXPR0014590
MOLINA
MI
01
—
RA630034
MCARE GROUP PIN
MI
Enumeration date
06/12/2006
Last updated
06/05/2025
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