Eastland Diagnostic PC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

4301032665 Issued in MI

Legal business name

EASTLAND DIAGNOSTIC PC

Practice address

25710 Kelly Rd
Roseville, MI 48066-4959

Phone

(586) 779-4610

Fax

(586) 779-0003

NPI assigned

Feb 11, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mehdi Mahmoodzadegan, M.D.

Title

President

Phone

(586) 779-4610

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1171152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1629119649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25710 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664959",
            "telephone_number": "586-779-4610",
            "fax_number": "586-779-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25710 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664959",
            "telephone_number": "586-779-4610",
            "fax_number": "586-779-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAND DIAGNOSTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-11",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MAHMOODZADEGAN",
        "authorized_official_first_name": "MEHDI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-779-4610",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MI",
            "license": "4301032665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376494",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE NETWORK HMO",
            "identifier": "3005041671",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marissa Dulcamaro, LMSW
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• Eastlake Pediatrics PC
• Jeffrey Waldemar Easton II, D.D.S.
• Eastside Cardiovascular Medicine
• Eastside Cardiovascular Medicine, P.C.
• Eastside Diagnostics LLC
• Ecg Scanning & Medical Services Inc

• Radiology Clinic/Center in Roseville, MI
• Providers in Roseville, MI by specialty
• Radiology Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.