MEDICARE: SHERIDAN RADIOLOGY SERVICES OF KENTUCKY, 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1417246075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN RADIOLOGY SERVICES OF KENTUCKY, INC

Provider Business Mailing Address
First Line	:	PO BOX 452228
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33345-2228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N OCEAN BLVD
Second Line	:	#802
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7152
Country	:	US
Telephone Number	:	954-565-5249
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GILBERT L DROZDOW
Credential	:	MD
Telephone Number	:	954-838-2371

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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