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General NPI Number Information
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NPI Number | 1417121690
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Entity Type | Organization
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Legal Business Name | METROPOLITAN DIAGNOSTICS PA
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 12797 W FOREST HILL BLVD STE B
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City | WELLINGTON
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State | FL
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Zip | 33414-4763
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Country | US
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Telephone | 561-358-8462
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Fax | 561-792-0217
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Provider Business Mailing Address
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Address Line | 12797 W FOREST HILL BLVD STE B
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City | WELLINGTON
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State | FL
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Zip | 33414-4763
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Country | US
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Telephone | 561-358-8462
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Fax | 561-792-0217
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD H TIETJEN
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Credential |
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Telephone | 561-358-8462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC6776
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License Number State | FL
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