MEDICARE: ICARE360 IMAGING 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1720891005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE360 IMAGING LLC

Provider Business Mailing Address
First Line	:	7615 JACQUE RD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7132
Country	:	US
Telephone Number	:	813-692-7947
Fax Number	:	813-692-7937

Provider Business Practice Location Address
First Line	:	7615 JACQUE RD
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7132
Country	:	US
Telephone Number	:	813-692-7947
Fax Number	:	813-692-7937

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VINOD K RAXWAL
Credential	:	MD
Telephone Number	:	813-692-7947

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	01/30/2025

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Directions to “ICARE360 IMAGING LLC ” Practice Location

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