Healthcare Provider Details

I. General information

NPI: 1881851061
Provider Name (Legal Business Name): CDI OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 W BROAD ST
COLUMBUS OH
43222-1421
US

IV. Provider business mailing address

5775 WAYZATA BLVD SUITE 400
ST LOUIS PARK MN
55416-1222
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-4860
  • 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: JAMES F. STANLEY
Title or Position: OFFICER (CFO)
Credential:
Phone: 952-543-6504