Organization
FARZANA BUTT
Active
Other names
ULTRASOUND CLINIC DIAGNOSTIC
Organization subpart
No
Provider details
NPI number
Authorized official
NANJAPA C SADASIVAN MD (MEDICAL DIRECTOR)
(517) 784-5150
Entity
Organization
Contact information
Practice address
2575 SPRING ARBOR RD, SUITE #500, JACKSON, MI 49203-3652
(517) 784-5150
Mailing address
2575 SPRING ARBOR RD, SUITE#500, JACKSON, MI 49203-3652
(517) 784-5150
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
NS033633
MI
2471V0105X
Vascular Sonography Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104486551
—
MI
01
—
128472
GLP
—
01
—
1620009
PHP
—
01
—
300C810210
BC
—
01
—
380030
M CARE OP
—
01
—
5970
HPL
—
01
—
P71951
BCN
—
Enumeration date
01/26/2007
Last updated
04/11/2011
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