Healthcare Provider Details

I. General information

NPI: 1073953451
Provider Name (Legal Business Name): TWIN CITIES DIAGNOSTIC CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 WAYZATA BOULEVARD
GOLDEN VALLEY MN
55426
US

IV. Provider business mailing address

7570 WAYZATA BOULEVARD
GOLDEN VALLEY MN
55426
US

V. Phone/Fax

Practice location:
  • Phone: 763-717-8754
  • Fax: 763-717-8758
Mailing address:
  • Phone: 763-717-8754
  • Fax: 763-717-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATIANA FLEITES
Title or Position: OFFICER
Credential:
Phone: 305-643-0300