NPIMap

Organization Active NPI

Mid Michigan Diagnostic Corp

  • Neurology Physician
  • Flint, MI
National Provider Identifier
1285800417
Registry record updated Jan 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
KH072133 Issued in MI
Legal business name
MID MICHIGAN DIAGNOSTIC CORP
Practice address
1309 S Linden Rd Ste a
Flint, MI 48532-3443
Phone
(810) 606-0656
Fax
(810) 606-0662
NPI assigned
May 7, 2008
Last updated
Jan 24, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Zakwan Aboudane
Title
Manager
Phone
(810) 606-0656

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X 4301084975 MI
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X KH072133 MI Primary

Addresses

Primary practice location

1309 S Linden Rd Ste a
Flint, MI 48532-3443

Mailing address

1309 S Linden Rd Ste a
Flint, MI 48532-3443
Phone (810) 606-0656

Other identifiers 2

IdentifierTypeStateIssuer
104809895MedicaidMI
105207154MedicaidMI

Other names 1

  • Mid Michigan Diagnostics Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1285800417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 S LINDEN RD STE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323443",
            "telephone_number": "810-606-0656",
            "fax_number": "810-606-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 S LINDEN RD STE A",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323443",
            "telephone_number": "810-606-0656",
            "fax_number": "810-606-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID MICHIGAN DIAGNOSTIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-07",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "ABOUDANE",
        "authorized_official_first_name": "ZAKWAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "810-606-0656",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MI",
            "license": "4301084975",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "KH072133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104809895",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105207154",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Michigan Diagnostics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.