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General NPI Number Information
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NPI Number | 1376716530
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Entity Type | Organization
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Legal Business Name | ADVANCED MOLECULAR IMAGING OF FLORIDA LLC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 2650 N MILITARY TRL
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City | BOCA RATON
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State | FL
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Zip | 33431-6350
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Country | US
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Telephone | 954-557-8408
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 N MILITARY TRL
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City | BOCA RATON
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State | FL
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Zip | 33431-6350
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Country | US
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Telephone | 954-557-8408
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL FAGIEN
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Credential | MD
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Telephone | 954-557-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | ME59548
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | ME59548
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME59548
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME59548
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | ME59548
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License Number State | FL
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