Organization
SOUTHFIELD RADIOLOGY ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDSA NEGUSSIE MD (PRESIDENT)
(248) 308-2745
Entity
Organization
Contact information
Practice address
23100 PROVIDENCE DR, SUITE 420, SOUTHFIELD, MI 48075-3646
(248) 569-4353
(248) 569-5227
Mailing address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 569-4353
(248) 569-5227
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F36131
BLUE CROSS BLUE SHIELD
MI
01
—
A3477
RAILROAD MEDICARE
MI
Enumeration date
07/07/2006
Last updated
12/04/2025
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