Organization
EASTLAND DIAGNOSTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MEHDI MAHMOODZADEGAN M.D. (PRESIDENT)
(586) 779-4610
Entity
Organization
Contact information
Practice address
25710 KELLY RD, ROSEVILLE, MI 48066-4959
(586) 779-4610
(586) 779-0003
Mailing address
25710 KELLY RD, ROSEVILLE, MI 48066-4959
(586) 779-4610
(586) 779-0003
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
4301032665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376494
—
MI
01
—
3005041671
BLUECARE NETWORK HMO
MI
Enumeration date
02/11/2007
Last updated
04/20/2008
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