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General NPI Number Information
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NPI Number | 1063013761
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Entity Type | Organization
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Legal Business Name | CONVENIENT ULTRASOUNDS
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Dates
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Enumeration Date | 11/08/2020
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 10822 LANTERN VIEW DR APT 307
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City | FISHERS
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State | IN
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Zip | 46038-4204
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Country | US
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Telephone | 916-216-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 10822 LANTERN VIEW DR APT 307
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City | FISHERS
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State | IN
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Zip | 46038-4204
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Country | US
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Telephone | 916-216-4410
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DMITRI ZAICHENKO
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Credential |
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Telephone | 765-400-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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