Healthcare Provider Details

I. General information

NPI: 1629475652
Provider Name (Legal Business Name): AZ TECH RADIOLOGY AND OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CHAPIN ST
BELOIT WI
53511-6472
US

IV. Provider business mailing address

2653 W GUADALUPE RD SUITE 201
MESA AZ
85202-7200
US

V. Phone/Fax

Practice location:
  • Phone: 608-362-2343
  • Fax:
Mailing address:
  • Phone: 480-889-3500
  • Fax: 480-889-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. RAKESH PAHWA
Title or Position: CHAIRMAN-CEO
Credential:
Phone: 480-706-1096