Healthcare Provider Details

I. General information

NPI: 1043936032
Provider Name (Legal Business Name): PDI TOLEDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 BAGLEY RD STE 202
MIDDLEBURG HEIGHTS OH
44130-3348
US

IV. Provider business mailing address

19250 BAGLEY RD STE 202
MIDDLEBURG HEIGHTS OH
44130-3348
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-9970
  • Fax: 440-260-9980
Mailing address:
  • Phone: 440-260-9970
  • Fax: 440-260-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACK CHAMPNEY CORNELL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 440-223-8848