Healthcare Provider Details
I. General information
NPI: 1407142631
Provider Name (Legal Business Name): FLORIDA UNITED RADIOLOGY, LC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/27/2011
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
651 E 25TH ST
HIALEAH FL
33013-3814
US
IV. Provider business mailing address
PO BOX 19510
FORT LAUDERDALE FL
33318-0510
US
V. Phone/Fax
- Phone: 305-693-6100
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
GILBERT
L.
DROZDOW
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371