Healthcare Provider Details

I. General information

NPI: 1174754683
Provider Name (Legal Business Name): SPECTRUM DIAGNOSTIC IMAGING OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 BAGLEY RD
CLEVELAND OH
44130-3347
US

IV. Provider business mailing address

4400 ROCKSIDE RD
INDEPENDENCE OH
44131-2168
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-9970
  • Fax: 440-260-9980
Mailing address:
  • Phone: 216-584-2900
  • Fax: 216-584-2901

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 Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ZHUK
Title or Position: CEO
Credential: M.D.
Phone: 216-584-2900