Healthcare Provider Details

I. General information

NPI: 1245657212
Provider Name (Legal Business Name): FLORIDA UNITED RADIOLOGY, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11107 CONISTON WAY
WINDERMERE FL
34786-5410
US

IV. Provider business mailing address

PO BOX 19510
FORT LAUDERDALE FL
33318-0510
US

V. Phone/Fax

Practice location:
  • Phone: 954-839-3591
  • 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 DROZDOW
Title or Position: PRESIDENT
Credential:
Phone: 954-838-2371