Organization
NORTHLAND RADIOLOGY INC
Active
Organization
NORTHLAND RADIOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAKASH GANDHI (ADMINISTRATOR)
(248) 827-7200
Entity
Organization
Contact information
Practice address
20905 GREENFIELD RD, STE 105, SOUTHFIELD, MI 48075-5344
(248) 569-0296
(248) 569-3390
Mailing address
26222 TELEGRAPH RD, STE 100, SOUTHFIELD, MI 48033-5318
(248) 827-7200
(248) 827-2641
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
207UN0902X
Nuclear Imaging & Therapy Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084N0400X
Neurology Physician
—
—
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F37368
BCBS
MI
Enumeration date
06/06/2006
Last updated
11/13/2013
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