Basic Information
| Provider Information | |||||||||
| NPI: | 1184869349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESEE MEDICAL IMAGING PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 STONEBRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485325407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102309215 | ||||||||
| FaxNumber: | 8102309225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GENESYS PKWY | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484398065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106065000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2008 | ||||||||
| LastUpdateDate: | 12/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | POLANCO | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8102309215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.