MEDICARE: MILLENNIUM IMAGING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC5297	FL

General Provider Information

NPI Number	:	1306848825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM IMAGING, INC.

Provider Business Mailing Address
First Line	:	PO BOX 11440
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34282-1440
Country	:	US
Telephone Number	:	941-755-5257
Fax Number	:	941-755-4856

Provider Business Practice Location Address
First Line	:	10910 E STATE ROAD 70
Second Line	:	SUITE 103
City	:	BRADENTON
State	:	FL
Zip	:	34202-8406
Country	:	US
Telephone Number	:	941-755-5257
Fax Number	:	941-755-4856

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH E LADIKA JR
Credential	:	R.T., C.V.T.
Telephone Number	:	941-755-5257

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2020

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