Healthcare Provider Details

I. General information

NPI: 1154517191
Provider Name (Legal Business Name): DIAGNOSTIC MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 SW 38TH AVE
FT LAUDERDALE FL
33312-8227
US

IV. Provider business mailing address

5245 SW 38TH AVE
FT LAUDERDALE FL
33312-8227
US

V. Phone/Fax

Practice location:
  • Phone: 954-646-1212
  • Fax:
Mailing address:
  • Phone: 954-646-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE ROZENBERG
Title or Position: CEO
Credential: RPSGT
Phone: 954-646-1212