=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699232223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDEAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2019
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1192 BEMBRIDGE DR
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-690-6360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1192 BEMBRIDGE DR
-----------------------------------------------------
City | ROCHESTER HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-690-6360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROMAN KOBITA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-690-6360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------