Organization
SOUTHGATE X-RAY NUCLEAR MEDICINE & ULTRASOUND, PC
Active
Other names
Southgate Radiology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS PAUL VOLLMAN DO (PRESIDENT)
(734) 281-6600
Entity
Organization
Contact information
Practice address
15300 TRENTON RD, SOUTHGATE, MI 48195-2027
(734) 281-6600
Mailing address
15300 TRENTON RD, SOUTHGATE, MI 48195-2027
(734) 281-6600
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Q26265
BLUE CROSS BLUE SHIELD MI
MI
01
—
3188200395
HEALTHPLUS OF MI
MI
01
—
CC0372
RAILROAD MEDICARE
MI
Enumeration date
07/18/2006
Last updated
08/22/2020
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