Healthcare Provider Details

I. General information

NPI: 1467748608
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: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SE HILLMOOR DR
PORT SAINT LUCIE FL
34952-7539
US

IV. Provider business mailing address

PO BOX 19510
FORT LAUDERDALE FL
33318-0510
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KATHY KONDAS
Title or Position: OFFICER
Credential:
Phone: 877-328-1119