Organization
RADIOLOGY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM HACKETTE MD (MANAGER)
(727) 422-4680
Entity
Organization
Contact information
Practice address
27789 MOUND RD STE 100, WARREN, MI 48092-2697
(313) 209-3353
(313) 406-7255
Mailing address
42383 GARFIELD RD UNIT 380560, CLINTON TWP, MI 48038-7718
(727) 422-4680
(313) 406-7255
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
1043253602
MI
Other
Enumeration date
08/23/2016
Last updated
04/30/2021
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