Organization
SE RADIOLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHOK B. JAIN M.D. (OWNER/PRESIDENT)
(734) 326-5030
Entity
Organization
Contact information
Practice address
4491 VENOY RD, WAYNE, MI 48184-2530
(734) 326-5030
Mailing address
4000 2ND ST, WAYNE, MI 48184-1715
(734) 326-5030
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300H276180
BCBS OF MICHIGAN
MI
01
—
CE4307
RR MEDICARED
MI
Enumeration date
01/09/2008
Last updated
06/12/2008
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