Organization
PARK PLAZA RADIOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. APPARAO MUKKAMALA MD (PRESIDENT)
(810) 424-4761
Entity
Organization
Contact information
Practice address
G 1071 N BALLENGER HWY, SUITE 102, FLINT, MI 48504
(810) 235-0668
(810) 235-8928
Mailing address
PO BOX 4459, FLINT, MI 48504-4850
(810) 424-4761
(810) 424-4871
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
4301031703
MI
2085N0700X
Neuroradiology Physician
4301042515
MI
2085R0202X
Diagnostic Radiology Physician
4301031588
MI
2085R0202X
Diagnostic Radiology Physician
4301034123
MI
2085R0202X
Diagnostic Radiology Physician
4301034675
MI
2085R0202X
Diagnostic Radiology Physician
4301037709
MI
2085R0202X
Diagnostic Radiology Physician
4301046932
MI
2085R0202X
Diagnostic Radiology Physician
4301057046
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301406912
MI
2085R0204X
Vascular & Interventional Radiology Physician
4301037112
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B56014
BCBS COMMON PROVIDER CODE
MI
Enumeration date
08/01/2006
Last updated
09/11/2025
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