Healthcare Provider Details

I. General information

NPI: 1295928927
Provider Name (Legal Business Name): TRIAD RADIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E MARION AVE
PUNTA GORDA FL
33950-3819
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: MR. MILES E GILMAN
Title or Position: PRESIDENT
Credential:
Phone: 305-665-1197