Organization
NORTHCOAST RADIOLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES S HENRY MD (PRESIDENT)
(906) 225-3540
Entity
Organization
Contact information
Practice address
420 W MAGNETIC ST, MARQUETTE, MI 49855-2711
(906) 225-3540
Mailing address
420 W MAGNETIC ST, MARQUETTE, MI 49855-2711
(906) 225-3540
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E21065
BLUE CROSS BLUE SHIELD
MI
05
—
21295500
—
WI
01
—
DE1249
RAILROAD MEDICARE
MI
Enumeration date
07/06/2006
Last updated
08/22/2020
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