Organization
SOUTHFIELD RADIOLOGY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER L GONDA JR. M.D. (PRESIDENT)
(248) 569-4353
Entity
Organization
Contact information
Practice address
6245 N INKSTER RD, GARDEN CITY, MI 48135-4001
(734) 458-3412
(734) 677-7407
Mailing address
PO BOX 1108, ATTN: BARB SIMMONS, ANN ARBOR, MI 48106-1108
(734) 677-7400
(734) 677-7407
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK5218
RR MEDICARE#
MI
Enumeration date
07/28/2006
Last updated
01/17/2008
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