Healthcare Provider Details

I. General information

NPI: 1952404519
Provider Name (Legal Business Name): PALM BEACH BROWARD MEDICAL IMAGING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E HILLSBORO BLVD SUITE 110
DEERFIELD BEACH FL
33441-4356
US

IV. Provider business mailing address

1500 E HILLSBORO BLVD SUITE 110
DEERFIELD BEACH FL
33441-4356
US

V. Phone/Fax

Practice location:
  • Phone: 954-426-3006
  • Fax: 954-481-9318
Mailing address:
  • Phone: 954-426-3006
  • Fax: 954-481-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC3645
License Number StateFL

VIII. Authorized Official

Name: KAYA COLAK
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 954-426-3006