Healthcare Provider Details

I. General information

NPI: 1437908373
Provider Name (Legal Business Name): RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OSPREY BLVD
BARTOW FL
33830-3308
US

IV. Provider business mailing address

PO BOX 20027
TAMPA FL
33622-0027
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL B. ESPOSITO
Title or Position: PRESIDENT
Credential: MD
Phone: 863-577-0303