Healthcare Provider Details

I. General information

NPI: 1275750481
Provider Name (Legal Business Name): MIDWEST MODERN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 CHERRY ST SUITE 100
TOLEDO OH
43608-2625
US

IV. Provider business mailing address

2409 CHERRY ST SUITE 100
TOLEDO OH
43608-2625
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-3700
  • Fax: 419-251-6827
Mailing address:
  • Phone: 419-251-3700
  • Fax: 419-251-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMEER KABOUR
Title or Position: DIRECTOR
Credential: M.D.
Phone: 419-251-7795