Provider Demographics
NPI:1174966311
Name:MICHIGAN TECHNOLOGY PARTNERS LLC
Entity type:Organization
Organization Name:MICHIGAN TECHNOLOGY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-427-0020
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0970
Mailing Address - Country:US
Mailing Address - Phone:313-427-0020
Mailing Address - Fax:313-731-0422
Practice Address - Street 1:15201 CENTURY DR
Practice Address - Street 2:SUITE 606
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1232
Practice Address - Country:US
Practice Address - Phone:313-427-0020
Practice Address - Fax:313-731-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)