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NPI Code Detail

MEDICARE: ICARE DIAGNOSTIC IMAGING LLC

MEDICARE: ICARE DIAGNOSTIC 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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number : 1932627684
Entity Type Code : Organization
Provider Name (Legal Business Name) : ICARE DIAGNOSTIC IMAGING LLC
Provider Business Mailing Address
First Line : 2781 FREEWAY BLVD STE 160
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55430-1765
Country : US
Telephone Number : 763-244-8020
Fax Number : 763-244-8021
Provider Business Practice Location Address
First Line : 2781 FREEWAY BLVD STE 160
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55430-1765
Country : US
Telephone Number : 763-244-8020
Fax Number : 763-244-8021
Authorized Official
Title or Position : MANAGER
Name : MALLIKARJUNARAO KASAM
Credential :
Telephone Number : 763-244-8020
Provider Enumeration Date : 09/01/2017
Last Update Date : 07/21/2022

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Directions to “ICARE DIAGNOSTIC IMAGING LLC ” Practice Location

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