MEDICARE: LAM MOBILE DIAGNOSTIC 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
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier		FL

General Provider Information

NPI Number	:	1992900880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAM MOBILE DIAGNOSTIC INC

Provider Business Mailing Address
First Line	:	435 HIALEAH DR
Second Line	:	UPSTAIRS OFFFICE #6
City	:	HIALEAH
State	:	FL
Zip	:	33010-5358
Country	:	US
Telephone Number	:	305-805-0014
Fax Number	:	305-805-0445

Provider Business Practice Location Address
First Line	:	435 HIALEAH DR
Second Line	:	UPSTAIRS OFFFICE #6
City	:	HIALEAH
State	:	FL
Zip	:	33010-5358
Country	:	US
Telephone Number	:	305-805-0014
Fax Number	:	305-805-0445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FABIAN MELNIK
Credential	:
Telephone Number	:	305-805-0014

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	11/08/2007

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Directions to “LAM MOBILE DIAGNOSTIC INC ” Practice Location

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