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General NPI Number Information
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NPI Number | 1467748608
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Entity Type | Organization
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Legal Business Name | FLORIDA UNITED RADIOLOGY, LC
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 1700 SE HILLMOOR DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7539
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Country | US
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Telephone | 772-335-9600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19510
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City | FORT LAUDERDALE
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State | FL
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Zip | 33318-0510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 877-328-1119
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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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