Basic Information
| Provider Information | |||||||||
| NPI: | 1013025709 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWAYGO AREA RADIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9322 | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063646700 | ||||||||
| FaxNumber: | 6163644960 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 S SULLIVAN ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163646700 | ||||||||
| FaxNumber: | 6163644960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 08/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | DILLON | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6163646700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.