Organization
PSI RADIOLOGICAL SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR COLLADO M.D,. PH.D (RADIOLOGIST)
(313) 962-2133
Entity
Organization
Contact information
Practice address
8529 E 8 MILE RD, WARREN, MI 48089-3067
(586) 619-7025
(586) 619-7267
Mailing address
547 E JEFFERSON AVE, DETROIT, MI 48226-4324
(313) 962-2133
(313) 962-2134
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
24834
MI
261QR0200X
Radiology Clinic/Center
Primary
24834
MI
261QR0208X
Mobile Radiology Clinic/Center
24834
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H228030
BCBS CROSSOVER
MI
05
—
114483540
—
MI
Enumeration date
11/02/2006
Last updated
04/23/2011
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