Healthcare Provider Details

I. General information

NPI: 1679800726
Provider Name (Legal Business Name): ALTAMONTE SPRINGS DIAGNOSTIC IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 GLADES RD SUITE B1
BOCA RATON FL
33434-4074
US

IV. Provider business mailing address

1150 S SEMORAN BLVD SUITE C
ORLANDO FL
32807-1424
US

V. Phone/Fax

Practice location:
  • Phone: 561-218-9011
  • Fax: 561-218-9012
Mailing address:
  • Phone: 407-482-5253
  • Fax: 407-482-5254

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: MR. RONALD I LANDAU
Title or Position: OWNER
Credential: M.D.
Phone: 407-482-5253