Organization
EASTSIDE DIAGNOSTICS LLC
Active
Parent organization
MAXIM L.L.C.
Other names
Maxim MRI
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAXIM L.L.C.
Authorized official
JENNIFER WATSON NP-C (ADMINISTRATOR)
(248) 709-7072
Entity
Organization
Contact information
Practice address
25100 KELLY RD STE B, ROSEVILLE, MI 48066-4910
(248) 262-7379
Mailing address
22000 GREENFIELD RD, OAK PARK, MI 48237-2500
(248) 709-7072
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
08/19/2020
Last updated
08/19/2020
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