Interventional Radiology Order Form

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INTERVENTIONAL ... 口Relevant Pathology Report(s) 口Outside Radiology Report(s) 口Insurance Card(s) ... CPT Codes ... equivalent informational sheet).
Ph 517-353-4920 (Ext 4) Fax 517-432-2243 www.rad.msu.edu Tax ID 386005984 NPI 1891747614

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