Provider Demographics
NPI:1275750481
Name:MIDWEST MODERN IMAGING, LLC
Entity Type:Organization
Organization Name:MIDWEST MODERN IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:KABOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-251-7795
Mailing Address - Street 1:2409 CHERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2625
Mailing Address - Country:US
Mailing Address - Phone:419-251-3700
Mailing Address - Fax:419-251-6827
Practice Address - Street 1:2409 CHERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2625
Practice Address - Country:US
Practice Address - Phone:419-251-3700
Practice Address - Fax:419-251-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0810406Medicare PIN