Organization
TAHQUAMENON MEDICAL IMAGING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY ROWE DO (PRESIDENT)
(906) 293-9200
Entity
Organization
Contact information
Practice address
502 W HARRIE ST, NEWBERRY, MI 49868-1209
(906) 293-9200
Mailing address
502 W HARRIE ST, NEWBERRY, MI 49868-1209
(906) 293-9200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3154800035
BLUE CROSS
MI
Enumeration date
07/21/2006
Last updated
03/18/2008
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