NPIMap

Organization Active NPI

NDS Radiology Inc.

  • Diagnostic Radiology Physician
  • Novi, MI
National Provider Identifier
1649418211
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
NDS RADIOLOGY INC.
Practice address
28700 Cabot Dr Ste 500
Novi, MI 48377-2949
Phone
(248) 476-6980
Fax
(248) 476-7462
NPI assigned
Feb 4, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Mr. Michael Ketslakh
Title
Ceo
Phone
(248) 476-6980

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

28700 Cabot Dr Ste 500
Novi, MI 48377-2949

Mailing address

28700 Cabot Dr Ste 500
Novi, MI 48377-2949
Phone (248) 476-6980

Other names 1

  • National Diagnostic Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090512000117 MI Part B Supplier - Clinic/Group Practice 2062408875 Receives reassigned benefits from 34 practitioners
Practice locations: Novi, MI

National Provider Directory

National Provider Directory

Locations

17480 Silver Pkwy
Fenton, MI 48430
Phone (248) 476-6980

414 Perry Rd
Ste 3
Grand Blanc, MI 48439
Phone (248) 476-6980

28700 Cabot Dr
Ste 500
Novi, MI 48377
Phone (248) 476-6980

Practitioners & affiliated clinicians

Practitioners 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1233705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1649418211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28700 CABOT DR STE 500",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772949",
            "telephone_number": "248-476-6980",
            "fax_number": "248-476-7462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28700 CABOT DR STE 500",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772949",
            "telephone_number": "248-476-6980",
            "fax_number": "248-476-7462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NDS RADIOLOGY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-04",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "KETSLAKH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-476-6980",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "National Diagnostic Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "National Diagnostic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Novi, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.