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General NPI Number Information
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NPI Number | 1073790291
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Entity Type | Organization
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Legal Business Name | CUSTOM RADIOLOGY SOLUTIONS LLC
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 13731 METROPOLIS AVE
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City | FORT MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-333-2484
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Fax | 239-333-2483
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Provider Business Mailing Address
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Address Line | 13300-56 S. CLEVELAND AVE #305 PMB#239
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 239-333-2484
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Fax | 239-333-2483
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Authorized Official
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Title or Position | MD/OWNER
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Name | CHAIM J MARGOLIN
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Credential | MD
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Telephone | 239-333-2484
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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 | ME62306
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License Number State | FL
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