Provider Demographics
NPI:1093769531
Name:U.S. MOBILE DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:U.S. MOBILE DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TRANTALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-461-8624
Mailing Address - Street 1:3907 N FEDERAL HWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6042
Mailing Address - Country:US
Mailing Address - Phone:954-461-8624
Mailing Address - Fax:954-596-8132
Practice Address - Street 1:3907 N FEDERAL HWY
Practice Address - Street 2:SUITE 112
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6042
Practice Address - Country:US
Practice Address - Phone:954-461-8624
Practice Address - Fax:954-596-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6512213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC6512OtherSTATE LICENSE NUMBER