Provider Demographics
NPI:1053575118
Name:NORTH MACOMB MRT CENTER LLC
Entity type:Organization
Organization Name:NORTH MACOMB MRT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMR
Authorized Official - Middle Name:M
Authorized Official - Last Name:AREF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-868-9060
Mailing Address - Street 1:44000 GARFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0000
Mailing Address - Country:US
Mailing Address - Phone:586-412-4423
Mailing Address - Fax:586-412-4102
Practice Address - Street 1:17900 23 MILE ROAD
Practice Address - Street 2:
Practice Address - City:MACOMB TWP
Practice Address - State:MI
Practice Address - Zip Code:48042
Practice Address - Country:US
Practice Address - Phone:586-868-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty