Organization
MMG 1 PC
Active
Other names
MILLENIUM DIAGNOSTIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY A. TRIVAX M.D. (PRESIDENT)
(248) 851-1430
Entity
Organization
Contact information
Practice address
32255 NORTHWESTERN HWY STE 100, FARMINGTON HILLS, MI 48334-1573
(248) 945-0000
(248) 945-1819
Mailing address
29992 NORTHWESTERN HWY, SUITE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5182
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RM1200X
Magnetic Resonance Imaging (MRI) Internal Medicine Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M96210
MEDICARE PTAN
MI
05
—
1912933540
—
MI
01
—
700F314390
BLUE SHIELD GROUP
MI
01
—
CF9345
MEDICARE IS TYPE UNSPECIFIED
MI
01
—
CG6178
MEDICARE ID TYPE UNSPECIFIED
MI
01
—
CH5573
MEDICARE ID TYPE UNSPECIFIED
MI
01
—
CJ8411
MEDICARE ID TYPE UNSPECIFIED
MI
01
—
DA4193
MEDICARE ID TYPE UNSPECIFIED
MI
01
—
DD1976
MEDICARE IS TYPE UNSPECIFIED
MI
Enumeration date
06/24/2006
Last updated
12/23/2021
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