Provider Demographics
NPI:1487955845
Name:ULTRA DIAGNOSTIC SERVICES PC
Entity type:Organization
Organization Name:ULTRA DIAGNOSTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-258-4855
Mailing Address - Street 1:29600 NORTHWESTERN HIGHWAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1376
Mailing Address - Country:US
Mailing Address - Phone:313-258-4855
Mailing Address - Fax:248-671-5185
Practice Address - Street 1:29600 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1016
Practice Address - Country:US
Practice Address - Phone:313-258-4855
Practice Address - Fax:248-671-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028752207U00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty