Healthcare Provider Details

I. General information

NPI: 1497192892
Provider Name (Legal Business Name): MIDTOWN DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 N MIAMI AVE SUITE 4
MIAMI FL
33127-4439
US

IV. Provider business mailing address

2751 N MIAMI AVE SUITE 4
MIAMI FL
33127-4439
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-5100
  • Fax:
Mailing address:
  • Phone: 305-740-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO LEON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 305-740-5100