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Organization

GREAT LAKES RADIOLOGY PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VENICAT RUDRARAJU MD (OWNER)
(248) 884-0003
Entity
Organization

Contact information

Practice address
461 WEST HURON, PONTIAC, MI 48341
(248) 857-7200
Mailing address
4601 DOW RIDGE RD, ORCHARD LAKE, MI 48324-2326
(248) 884-0003

Taxonomy

Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
4301067927
MI

Other

Enumeration date
06/30/2015
Last updated
06/30/2015
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