MEDICARE: INDIANA MOBILE DIAGNOSTICS, 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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1184032393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA MOBILE DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	7895 BROADWAY
Second Line	:	SUITE # V
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5529
Country	:	US
Telephone Number	:	219-795-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	7895 BROADWAY
Second Line	:	SUITE # V
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5529
Country	:	US
Telephone Number	:	219-795-1313
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	NOMAN A KIDWAI
Credential	:	MD
Telephone Number	:	219-785-1313

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	03/09/2015

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