NPIMap

Organization Active NPI

Lifetest Michigan LLC

Doing business as EBT Heart & Body Imaging

  • Diagnostic Radiology Physician
  • Southfield, MI
National Provider Identifier
1336114503
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
LIFETEST MICHIGAN LLC
Doing business as
EBT Heart & Body Imaging
Practice address
26400 W 12 Mile Rd
Suite 114
Southfield, MI 48034
Phone
(248) 358-3223
Fax
(248) 358-3218
NPI assigned
Feb 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Alan D Hartz, MDNPI 1235170721
Title
President
Phone
(810) 733-6780

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

26400 W 12 Mile Rd
Suite 114
Southfield, MI 48034

Mailing address

G3239 Beecher Rd
Suite F
Flint, MI 48532
Phone (810) 733-6780

Other identifiers 1

IdentifierTypeStateIssuer
0F31831OtherMIBCBSM GROUP NUMBER

Other names 1

  • EBT Heart & Body Imaging Doing business as

National Provider Directory

National Provider Directory

Locations

Dept CH 17923
Palatine, IL 60055

26400 W 12 Mile Rd
Ste 114
Southfield, MI 48034
Phone (248) 358-3223

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336114503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "G3239 BEECHER RD",
            "address_2": "SUITE F",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48532",
            "telephone_number": "810-733-6780",
            "fax_number": "810-733-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26400 W 12 MILE RD",
            "address_2": "SUITE 114",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48034",
            "telephone_number": "248-358-3223",
            "fax_number": "248-358-3218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETEST MICHIGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARTZ",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-733-6780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP NUMBER",
            "identifier": "0F31831",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EBT Heart & Body Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.