Organization
FARMBROOK RADIOLOGY ASSOCIATES PC
Active
Other names
Farmbrook Radiology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
VICKY ROURKE (CREDENTIALING BILLING)
(248) 352-9525
Entity
Organization
Contact information
Practice address
29829 TELEGRAPH RD, SUITE L103, SOUTHFIELD, MI 48034-1376
(248) 352-9525
(248) 357-2959
Mailing address
29829 TELEGRAPH RD, SUITE L103, SOUTHFIELD, MI 48034-1376
(248) 352-9525
(248) 357-2959
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
00
MI
2085R0202X
Diagnostic Radiology Physician
00
MI
2085R0204X
Vascular & Interventional Radiology Physician
00
MI
2085U0001X
Diagnostic Ultrasound Physician
Primary
00
MI
261QR0206X
Mammography Clinic/Center
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007775-001
WELLNESS PLAN GROUP PIN
MI
01
—
132484
GREAT LAKE HEALTH PLAN
MI
01
—
5006540
AETNA GROUP PIN
MI
01
—
506377
CARE CHOICES GROUP PIN
MI
01
—
5101
CAPE HEALTH PLAN GROUP
MI
01
—
OF372090
BLUE SHIELD GROUP PIN
MI
01
—
QMXPR0014590
MOLINA
MI
01
—
RA630034
MCARE GROUP PIN
MI
Enumeration date
06/12/2006
Last updated
06/05/2025
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