MEDICARE: FLORIDA UNITED RADIOLOGY, LC

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	:	1467748608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA UNITED RADIOLOGY, LC

Provider Business Mailing Address
First Line	:	PO BOX 19510
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33318-0510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-335-9600
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	877-328-1119

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	07/08/2021

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