Organization
MICHIGAN SURGERY SPECIALISTS, P.C.
Active
Parent organization
MICHIGAN SURGERY SPECIALISTS, P.C.
Other names
Life Scan Imaging of Michigan
Organization subpart
Yes
Provider details
NPI number
Legal business name
MICHIGAN SURGERY SPECIALISTS, P.C.
Authorized official
MICHELE KUDLOR (BILLING MANAGER)
(586) 459-5592
Entity
Organization
Contact information
Practice address
11012 THIRTEEN MILE ROAD, SUITE 111, WARREN, MI 48093
(586) 558-8470
(586) 558-8481
Mailing address
31201 CHICAGO RD S STE C302, WARREN, MI 48093-5553
(586) 582-0864
(586) 582-0964
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301046061
MI
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2471C3401X
Computed Tomography Radiologic Technologist
4301046061
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300E017160
BCBS PIN NUMBER
MI
01
—
53317
RADIATION MACHINE REGISTR
—
Enumeration date
08/19/2005
Last updated
03/26/2025
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