Organization
PROFESSIONAL SONOCARDIOGRAPHIC IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR COLLADO M.D,. PH.D (RADIOLOGIST)
(313) 656-2151
Entity
Organization
Contact information
Practice address
1320 WILKINS ST, DETROIT, MI 48207-4802
(313) 656-2151
(313) 656-2152
Mailing address
547 E JEFFERSON AVE, DETROIT, MI 48226-4324
(313) 962-2133
(313) 962-2134
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E01 184
BC/BS
MI
05
—
114483504
—
MI
05
—
114483522
—
MI
01
—
470000653
RAILROAD MEDICARE
MI
Enumeration date
02/09/2006
Last updated
04/23/2011
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