MEDICARE: UNIVERSAL DIAGNOSTIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1083667489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL DIAGNOSTIC, INC.

Provider Business Mailing Address
First Line	:	5420 DASHWOOD DR
Second Line	:	STE # 201
City	:	HOUSTON
State	:	TX
Zip	:	77081-5357
Country	:	US
Telephone Number	:	713-662-3000
Fax Number	:	713-662-3049

Provider Business Practice Location Address
First Line	:	5420 DASHWOOD DR
Second Line	:	STE # 201
City	:	HOUSTON
State	:	TX
Zip	:	77081-5357
Country	:	US
Telephone Number	:	713-662-3000
Fax Number	:	713-662-3049

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKHAIL SHIFORENKO
Credential	:
Telephone Number	:	713-662-3000

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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