Healthcare Provider Details

I. General information

NPI: 1922342799
Provider Name (Legal Business Name): ICS RADIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 ARBOR CREST WAY
WEST PALM BEACH FL
33412-0000
US

IV. Provider business mailing address

PO BOX 452095
SUNRISE FL
33345-2095
US

V. Phone/Fax

Practice location:
  • Phone: 630-776-3318
  • 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: GILBERT L DROZDOW
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371