MEDICARE: MD MOBILE ULTRASOUND LLC

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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1699607390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD MOBILE ULTRASOUND LLC

Provider Business Mailing Address
First Line	:	3625 NEW JERSEY RD APT 142
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-7502
Country	:	US
Telephone Number	:	863-808-6108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 NEW JERSEY RD APT 142
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-7502
Country	:	US
Telephone Number	:	863-808-6108
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS ANDRES CALDERON RODRIGUEZ
Credential	:	RDCS ,RVT
Telephone Number	:	863-808-6108

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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