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NPI Code Detail

MEDICARE: ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC

MEDICARE: ALTAMONTE SPRINGS DIAGNOSTIC IMAGING 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
12085R0202XDiagnostic Radiology Physician
22085R0202XDiagnostic Radiology PhysicianHCC4167FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V2791OTHERFLBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1487750949
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTAMONTE SPRINGS DIAGNOSTIC IMAGING INC
Provider Business Mailing Address
First Line : 1150 S. SEMORAN BLVD
Second Line : SUITE C
City : ORLANDO
State : FL
Zip : 32807-1424
Country : US
Telephone Number : 407-482-5253
Fax Number : 407-482-5254
Provider Business Practice Location Address
First Line : 1150 S. SEMORAN BLVD
Second Line : SUITE D
City : ORLANDO
State : FL
Zip : 32807-1424
Country : US
Telephone Number : 407-482-5253
Fax Number : 407-482-5254
Authorized Official
Title or Position : OWNER
Name : DR. RONALD I LANDAU
Credential : M.D.
Telephone Number : 407-482-5253
Provider Enumeration Date : 09/15/2006
Last Update Date : 04/04/2011

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