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General NPI Number Information
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NPI Number | 1437615770
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Entity Type | Organization
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Legal Business Name | FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 661 E ALTAMONTE DR STE 130
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5102
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Country | US
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Telephone | 407-303-2155
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Fax | 407-303-2165
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Provider Business Mailing Address
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Address Line | 900 WINDERLEY PL STE 2100
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City | MAITLAND
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State | FL
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Zip | 32751-4191
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Country | US
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Telephone | 407-303-2155
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Fax | 407-303-2165
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Authorized Official
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Title or Position | VP/CFO
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Name | MICHAEL EDWARD MAZERES
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Credential |
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Telephone | 407-200-5403
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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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