Healthcare Provider Details

I. General information

NPI: 1134859846
Provider Name (Legal Business Name): RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16504 US 301 S
WIMAUMA FL
33598-2041
US

IV. Provider business mailing address

PO BOX 20027
TAMPA FL
33622-0027
US

V. Phone/Fax

Practice location:
  • Phone: 813-642-1000
  • Fax:
Mailing address:
  • Phone: 866-804-7649
  • 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: MICHAEL B. ESPOSITO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 863-688-2334