NPI 1154704948

Great Lakes Radiology PLLC

Organisation Radiography Radiologic Technologist Pontiac, MI

Practice location

Address: 461 West Huron, Pontiac, MI 48341
Phone: (248) 857-7200
Mailing address: 4601 Dow Ridge Rd, Orchard Lake, MI 48324-2326

Authorised official

Name: Venicat Rudraraju
Title: Owner
Phone: (248) 884-0003

Registered specialties

Radiography Radiologic Technologist Primary

Technologists, Technicians & Other Technical Service Providers Taxonomy 2471C3402X Licence 4301067927 (MI)

Other Radiologic Technologist providers in Michigan →

Registry record

NPI: 1154704948
Entity type: Organization
NPI issued: 30 Jun 2015
Record last updated: 30 Jun 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.