MEDICARE: MSN IMAGING PROFESSIONALS, 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	35-053437	OH
2	2085R0204X	Vascular & Interventional Radiology Physician	34-053437	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000169054	OTHER	OH	ANTHEM
3	92915	OTHER	OH	QUALCHOICE

General Provider Information

NPI Number	:	1679665772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSN IMAGING PROFESSIONALS, INC

Provider Business Mailing Address
First Line	:	4330 W 150TH ST
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1362
Country	:	US
Telephone Number	:	216-688-8000
Fax Number	:	216-688-0075

Provider Business Practice Location Address
First Line	:	4330 W 150TH ST
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1362
Country	:	US
Telephone Number	:	216-688-8000
Fax Number	:	216-688-0075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRADLEY A BLACKBURN
Credential	:	M.D.
Telephone Number	:	216-688-8000

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	09/11/2025

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Directions to “MSN IMAGING PROFESSIONALS, INC ” Practice Location

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