MEDICARE: SPECTRUM DIAGNOSTIC IMAGING OF OHIO LLC

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	2085U0001X	Diagnostic Ultrasound Physician
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1174754683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM DIAGNOSTIC IMAGING OF OHIO LLC

Provider Business Mailing Address
First Line	:	4400 ROCKSIDE RD
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2168
Country	:	US
Telephone Number	:	216-584-2900
Fax Number	:	216-584-2901

Provider Business Practice Location Address
First Line	:	19250 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3347
Country	:	US
Telephone Number	:	440-260-9970
Fax Number	:	440-260-9980

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARK ZHUK
Credential	:	M.D.
Telephone Number	:	216-584-2900

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	10/06/2009

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