Healthcare Provider Details

I. General information

NPI: 1174757082
Provider Name (Legal Business Name): QUANTUM IMAGING HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 N UNIVERSITY DR SUITE A
PEMBROKE PINES FL
33024-3603
US

IV. Provider business mailing address

2221 N UNIVERSITY DR SUITE A
PEMBROKE PINES FL
33024-3603
US

V. Phone/Fax

Practice location:
  • Phone: 954-985-6490
  • Fax:
Mailing address:
  • Phone: 954-985-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberOS9851
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN ADAM BURACK
Title or Position: OWNER
Credential: M.D.
Phone: 954-985-6490