Organization
DIAGNOSTIC IMAGING OF WEST BRANCH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY J WACKERLE (BUSINESS MANAGER)
(989) 893-6573
Entity
Organization
Contact information
Practice address
2463 S M-30, 335 E HOUGHTON AVE, WEST BRANCH, MI 48661
(989) 343-3141
(989) 343-3136
Mailing address
302 CENTER AVE, BAY CITY, MI 48708
(989) 893-6573
(989) 922-4737
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P113493
BCBS MI
—
Enumeration date
04/05/2006
Last updated
08/22/2020
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