Provider Demographics
NPI:1326397423
Name:RADIANT DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:RADIANT DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-355-9800
Mailing Address - Street 1:2415 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 112, BLDG 3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2809
Mailing Address - Country:US
Mailing Address - Phone:941-355-9800
Mailing Address - Fax:941-355-9811
Practice Address - Street 1:2415 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 112, BLDG 3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2809
Practice Address - Country:US
Practice Address - Phone:941-355-9800
Practice Address - Fax:941-355-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 106112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000933100Medicaid
FLCI888XOtherMEDICARE