Organization
GRAND TRAVERSE RADIOLOGISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE M LUNG MD (PRESIDENT)
(231) 935-0497
Entity
Organization
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-0497
Mailing address
PO BOX 30516, DEPT. 9516, LANSING, MI 48909-8016
(800) 475-6112
(423) 826-1286
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008081
MIDWEST HEALTH PLAN
MI
01
—
0B87605
BLUE CROSS BLUE SHIELD
MI
01
—
10399
M-CARE
MI
01
—
104756
CARE CHOICES
MI
05
—
12088500
—
WI
01
—
134232100
US DEPT. OF LABOR
MI
01
—
27837
COMMUNITY CHOICE MI
MI
01
—
280047
FEDERAL BLACK LUNG
MI
01
—
4055
PRIORITY HEALTH
MI
01
—
53556A
HEALTH ALLIANCE PLAN
MI
01
—
803002
COMMUNITY CARE PLAN
MI
01
—
CA3471
RAILROAD MEDICARE
MI
01
—
N16010
NORTHMED HMO
MI
01
—
XX00308
HEALTHPLUS OF MI
MI
Enumeration date
07/25/2006
Last updated
04/29/2020
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