Basic Information
| Provider Information | |||||||||
| NPI: | 1992899660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONROE RADIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 N. MACOMB | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342408400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 718 N MACOMB ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481627815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342408400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7342408400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | RA820059 | 01 | MI | M-CARE | OTHER | 023585 | 01 | MI | MIDWEST HEALTHPLAN | OTHER | 29694 | 01 | MI | COMMUNITY CHOICE OF MI | OTHER | 04437 | 01 | MI | PRIORITY HEALTH | OTHER | 707535 | 01 | MI | FAMILY HEALTH PLAN | OTHER | CI5353 | 01 | MI | RAILROAD MEDICARE | OTHER | 04849 | 01 | MI | PARAMOUNT HEALTHCARE | OTHER | 0E81027 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1528103 | 01 | MI | UNITED MINE WORKERS | OTHER | 116830 | 01 | MI | CARE CHOICES | OTHER | 13596600 | 01 | MI | US DEPT OF LABOR WC | OTHER |