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General NPI Number Information
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NPI Number | 1073353462
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Entity Type | Organization
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Legal Business Name | ICARE360 IMAGING LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 7323 GREEN SLOPE DR STE 101
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-1311
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Country | US
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Telephone | 813-692-7947
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Fax | 813-692-7937
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Provider Business Mailing Address
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Address Line | 17812 SAINT LUCIA ISLE DR
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City | TAMPA
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State | FL
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Zip | 33647-2714
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Country | US
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Telephone | 813-692-7947
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Fax | 813-692-7937
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINOD K RAXWAL
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Credential | MD
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Telephone | 813-692-7947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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