MEDICARE: CJM RADIOLOGY PA

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	261QR0200X	Radiology Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1093214132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJM RADIOLOGY PA

Provider Business Mailing Address
First Line	:	14631 SAFE LANDING CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4932
Country	:	US
Telephone Number	:	239-565-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	14631 SAFE LANDING CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4932
Country	:	US
Telephone Number	:	239-565-9266
Fax Number	:

Authorized Official
Title or Position	:	MD, CEO
Name	:	CHAIM MARGOLIN
Credential	:	MD
Telephone Number	:	239-565-9266

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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