Healthcare Provider Details

I. General information

NPI: 1588975213
Provider Name (Legal Business Name): SOUTHWEST FLORIDA REGIONAL IMAGING II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 TAMIAMI TRL
PORT CHARLOTTE FL
33952-5125
US

IV. Provider business mailing address

329 E OLYMPIA AVE
PUNTA GORDA FL
33950-3833
US

V. Phone/Fax

Practice location:
  • Phone: 941-637-9729
  • Fax: 941-637-3873
Mailing address:
  • Phone: 941-637-9729
  • Fax: 941-637-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MELVYN J KATZEN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 941-815-1988