EASTLAND DIAGNOSTIC PC (NPI# 1629119649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629119649 |
| Entity Type | Organization |
| Organization Name | EASTLAND DIAGNOSTIC PC |
| Practice Address |
25710 Kelly Rd Roseville MI 48066-4959 |
| Practice Telephone | 5867794610 |
| Practice Fax Number | 5867790003 |
| Mailing Telephone | 5867794610 |
| Mailing Fax Number | 5867790003 |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. MEHDI MAHMOODZADEGAN (PRESIDENT) |
| Authorized Official Telephone | 5867794610 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
4301032665 | MI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1376494 | 05 | |
| MI | BLUECARE NETWORK HMO | 3005041671 | 01 |
| Street Address |
25710 KELLY RD |
| City | ROSEVILLE |
| State | MI |
| Zip Code | 48066-4959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326040510 | Basem Almasri | Family Medicine | 25710 Kelly Rd, Ste 3, Roseville, MI 48066-4959 | 2005-06-01 |
| 1720511405 | Innovation Medicine, Pllc | Internal Medicine | 25710 Kelly Rd, Ste 3, Roseville, MI 48066-4959 | 2017-04-10 |
| 1497104616 | Jillian Tacia | Dietitian, Registered | 25710 Kelly Rd, Suite 3, Roseville, MI 48066-4959 | 2016-06-08 |
| 1134584279 | Jagruti Patel | Nurse Practitioner | 25710 Kelly Rd, Suite 3, Roseville, MI 48066-4959 | 2015-12-16 |
| 1447488572 | Josefine Lampasona Evola | Dietitian, Registered | 25710 Kelly Rd, Suite 3, Roseville, MI 48066-4959 | 2009-06-27 |
| 1164619623 | J H Park Md PC | Internal Medicine | 25710 Kelly Rd, Ste 3, Roseville, MI 48066-4959 | 2007-09-28 |
| 1982788980 | Francisco J. Rodriguez Md PC | Surgery | 25710 Kelly Rd, Suite 2, Roseville, MI 48066-4959 | 2006-10-25 |
| 1801845946 | Joung Ho Park | Internal Medicine | 25710 Kelly Rd, Ste 3, Roseville, MI 48066 | 2006-05-08 |
| 1376592691 | Francisco J Rodriguez | Surgery | 25710 Kelly Rd, Suite 2, Roseville, MI 48066-4959 | 2006-05-06 |
| 1730167644 | Borivoje Trifunovic | Internal Medicine | 25710 Kelly Rd, Suite 3, Roseville, MI 48066-4959 | 2006-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761400 | Louay Mansour Dds PC | Dentist | 27845 Gratiot Avenue, Roseville, MI 48066 | 2020-08-20 |
| 1558911842 | Jomy Jose | Nurse Practitioner | 25719 Salem St, Roseville, MI 48066 | 2019-09-18 |
| 1053963033 | Convenient Rv PC | Dentist | 19551 E. 10 Mile Rd, Roseville, MI 48066 | 2019-07-10 |
| 1063914539 | Colleen Meriweather | Registered Nurse | 27300 Spruce, Rosevilel, MI 48066 | 2018-03-01 |
| 1326565789 | Renee Suzette Hoelzeman | Nurse Practitioner | 18472 Meier St, Roseville, MI 48066 | 2017-08-27 |
| 1225561400 | Eugenia Dillard | Counselor | 28351 Gratiot Ave., Suite 3, Roseville, MI 48066 | 2017-04-05 |
| 1932651338 | Julie Plichota | Physical Therapist | 31120 Gratiot Ave, Roseville, MI 48066 | 2016-11-01 |
| 1699221325 | Jaquenta Glasker | Technician, Other | 26778 Rosewood, Roseville, MI 48066 | 2016-09-01 |
| 1609296144 | Peter Jajou | Dermatology | 18285 E 10 Mile Rd Ste 130, Roseville, MI 48066 | 2014-04-23 |
| 1619393899 | Katherine Michelle Johnson | Obstetrics & Gynecology | 29751 Little Mack Ave Ste B, Roseville, MI 48066 | 2014-03-11 |
| Find all providers in zip 48066 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629027594 | Suburban Radiologic Consultants, Ltd. | Clinic/Center | 2355 Hwy 36 W., Ste. 100, Roseville, MN 55113-5511 | 2006-05-09 |
| 1336598093 | Maxview, Inc | Clinic/Center | 1830 Sierra Gardens Dr, Suite 30, Roseville, CA 95661-2942 | 2016-06-03 |
| 1477712008 | Maxillofacial Imaging LLC | Clinic/Center | 2860 Snelling Ave N, Suite 2, Roseville, MN 55113-1438 | 2008-06-09 |
| 1821028200 | Dignity Health Medical Foundation | Clinic/Center | 2110 Professional Dr, Suite 190, Roseville, CA 95661-3752 | 2006-07-03 |
| 1427008937 | Suburban Imaging, LLC | Clinic/Center | 2355 Hwy 36 W., Ste. 100, Roseville, MN 55113 | 2006-05-12 |
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|---|---|---|---|---|
| 1265030068 | Copper Ridge Health PC | Clinic/Center | 4290 Copper Ridge Dr Ste 100, Traverse City, MI 49684-7256 | 2020-10-14 |
| 1043705163 | Elite Medical Diagnostics LLC | Clinic/Center | 30700 Telegraph Rd Ste 1536, Bingham Farms, MI 48025-4590 | 2018-07-01 |
| 1275022980 | Bellin Health Iron Mountain Inc | Clinic/Center | 440 Woodward Ave Ste A, Iron Mountain, MI 49801-4631 | 2018-05-08 |
| 1114416906 | Bellin Health Iron Mountain Inc | Clinic/Center | 2845 Highway Us2 and 41, Suite 202, Bark River, MI 49807 | 2018-05-07 |
| 1972092831 | Bellin Health Iron Mountain Inc | Clinic/Center | 2001 Minneapolis Ave Ste D, Gladstone, MI 49837-2060 | 2018-05-07 |
| 1437676871 | Diagnostic Solutions Pllc | Clinic/Center | 29877 Telegraph Rd Ste 400b, Southfield, MI 48034-7661 | 2017-08-25 |
| 1659769867 | Pavilion Imaging, LLC | Clinic/Center | 29201 Telegraph Rd Ste L-01, Southfield, MI 48034-1301 | 2014-12-23 |
| 1194143982 | Hurley Medical Center | Clinic/Center | 5494 S Dort Hwy, Flint, MI 48507-4483 | 2014-03-31 |
| 1003105420 | Envision Diagnostic Ultrasound Imaging LLC | Clinic/Center | 2715 Seneca St, Flint, MI 48504-5106 | 2011-04-06 |
| 1174848600 | Professional Diagnostic Imagiging Pllc | Clinic/Center | 4284 Echo Rd, Bloomfield Hills, MI 48302-1943 | 2010-03-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.