=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083458582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONQUEST IMAGING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2024
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9450 W COLONIAL DR
-----------------------------------------------------
City | OCOEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34761-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-863-4900
-----------------------------------------------------
Fax | 321-247-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9450 W COLONIAL DR
-----------------------------------------------------
City | OCOEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34761-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-863-4900
-----------------------------------------------------
Fax | 321-247-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LOAKHNAUTH RAMKISHUN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-575-6390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------