Organization
LIFETEST MICHIGAN LLC
Active
Other names
EBT Heart & Body Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN D HARTZ MD (PRESIDENT)
(810) 733-6780
Entity
Organization
Contact information
Practice address
26400 W 12 MILE RD, SUITE 114, SOUTHFIELD, MI 48034
(248) 358-3223
(248) 358-3218
Mailing address
G3239 BEECHER RD, SUITE F, FLINT, MI 48532
(810) 733-6780
(810) 733-8871
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F31831
BCBSM GROUP NUMBER
MI
Enumeration date
02/21/2006
Last updated
08/22/2020
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