Healthcare Provider Details

I. General information

NPI: 1003012683
Provider Name (Legal Business Name): MEDICAL IMAGING AND MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MILITARY TRL STE 1258
BOCA RATON FL
33431-6344
US

IV. Provider business mailing address

4519 GEORGE RD STE 100
TAMPA FL
33634-7329
US

V. Phone/Fax

Practice location:
  • Phone: 813-496-1075
  • Fax: 813-249-7762
Mailing address:
  • Phone: 813-496-1075
  • Fax: 813-249-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME19375
License Number StateFL

VIII. Authorized Official

Name: NORMAN HENRY PEVSNER
Title or Position: PRESIDENT
Credential: MD
Phone: 813-496-1075