Organization
MMG 1 PC
Active
Other names
MILLENNIUM DIAGNOSTIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY A. TRIVAX M.D. (PRESIDENT)
(248) 354-9666
Entity
Organization
Contact information
Practice address
32255 NORTHWESTERN HWY STE 100, FARMINGTON HILLS, MI 48334-1573
(248) 945-0000
(248) 945-1819
Mailing address
29992 NORTHWESTERN HWY STE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5182
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700F381060
BLUE CARE NETWORK
MI
Enumeration date
02/11/2009
Last updated
09/03/2024
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