NPIMap

Organization Active NPI

Mid Michigan Diagnostic Corp

  • Diagnostic Radiology Physician
  • Flint, MI
National Provider Identifier
1508800822
Registry record updated Jan 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
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
Jun 16, 2006
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
Owner
Phone
(810) 606-0656

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X 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 6

IdentifierTypeStateIssuer
104809901MedicaidMI
105207154MedicaidMI
104847878MedicaidMI
104809895MedicaidMI
104847751MedicaidMI
104847770MedicaidMI

Other names 1

  • Mid Michigan Diagnostics Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060203000215 MI Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1658385174 Practice locations: Flint, MI

National Provider Directory

National Provider Directory

Locations

1409 S Graham Rd
Flint, MI 48532
Phone (810) 235-2599

1409 S Graham Rd
Ste C
Flint, MI 48532
Phone (810) 766-9263

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1508800822",
    "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": "2006-06-16",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "ABOUDANE",
        "authorized_official_first_name": "ZAKWAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-606-0656",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104809901",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105207154",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104847878",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104809895",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104847751",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104847770",
            "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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.