Healthcare Provider Details

I. General information

NPI: 1245754035
Provider Name (Legal Business Name): RADIOLOGY PHYSICIAN SOLUTIONS OF INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S 7TH ST
TERRE HAUTE IN
47802-5709
US

IV. Provider business mailing address

7700 WEST SUNRISE BLVD 2ND FLOOR MAILSTOP - PL-14
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax: 954-851-1746
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. GILBERT L DROZDOW
Title or Position: OFFICER
Credential: MD
Phone: 954-838-2371