MEDICARE: RADIOLOGY UNLIMITED, PA

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	K9841	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0077HS	OTHER	TX	BCBS OF TX #

General Provider Information

NPI Number	:	1982680542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY UNLIMITED, PA

Provider Business Mailing Address
First Line	:	PO BOX 3432
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-3432
Country	:	US
Telephone Number	:	361-576-3680
Fax Number	:	361-576-4219

Provider Business Practice Location Address
First Line	:	815 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3025
Country	:	US
Telephone Number	:	361-576-3680
Fax Number	:	361-576-4219

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GHOLAMREZA MALEK
Credential	:	M.D.
Telephone Number	:	361-576-3680

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/22/2020

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Directions to “RADIOLOGY UNLIMITED, PA ” Practice Location

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