Provider Demographics
NPI:1235523762
Name:A&E DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:A&E DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSAGIEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-441-4460
Mailing Address - Street 1:5363 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5325
Mailing Address - Country:US
Mailing Address - Phone:317-441-4460
Mailing Address - Fax:219-756-4600
Practice Address - Street 1:5363 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5325
Practice Address - Country:US
Practice Address - Phone:317-441-4460
Practice Address - Fax:219-756-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061082A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty