Provider Demographics
NPI:1871518449
Name:RADIOLOGY SPECIALTIES PC
Entity type:Organization
Organization Name:RADIOLOGY SPECIALTIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-759-7525
Mailing Address - Street 1:13355 EAST TEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1240
Mailing Address - Country:US
Mailing Address - Phone:586-759-7540
Mailing Address - Fax:586-759-7574
Practice Address - Street 1:13355 EAST TEN MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1240
Practice Address - Country:US
Practice Address - Phone:586-759-7540
Practice Address - Fax:586-759-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E060181311Medicare ID - Type Unspecified