Healthcare Provider Details

I. General information

NPI: 1487642856
Provider Name (Legal Business Name): REGIONAL DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5183 MAYFIELD RD
LYNDHURST OH
44124-2405
US

IV. Provider business mailing address

4400 RENAISSANCE PKWY
WARRENSVILLE HTS OH
44128
US

V. Phone/Fax

Practice location:
  • Phone: 440-720-3000
  • Fax: 440-720-3006
Mailing address:
  • Phone: 216-464-8484
  • Fax: 216-464-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number0605IC
License Number StateOH

VIII. Authorized Official

Name: DR. MARK ZHUK
Title or Position: MANAGING PRINCIPLE AND MEDICAL DIRE
Credential: M.D.
Phone: 216-584-2900