Healthcare Provider Details

I. General information

NPI: 1053689877
Provider Name (Legal Business Name): MILLENIUM HEALTHCARE DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 NW 88TH AVE
TAMARAC FL
33321-2517
US

IV. Provider business mailing address

2929 S CARAWAY RD SUITE 6
JONESBORO AR
72401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 954-720-0903
  • Fax: 954-720-4583
Mailing address:
  • Phone: 870-275-7749
  • Fax: 870-275-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberHCC5165
License Number StateFL

VIII. Authorized Official

Name: MR. MIROSLAV JAKSIC
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 810-623-3211