Healthcare Provider Details

I. General information

NPI: 1376745687
Provider Name (Legal Business Name): METROPOLITAN DIAGNOSTIC ULTRASOUND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ALAN CT # 333
FLORENCE KY
41042-5360
US

IV. Provider business mailing address

34 ALAN CT # 333
FLORENCE KY
41042-5360
US

V. Phone/Fax

Practice location:
  • Phone: 859-991-3593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number70562
License Number StateKY

VIII. Authorized Official

Name: MR. JUSTICE DANIELS
Title or Position: PRESIDENT
Credential:
Phone: 859-991-3593