Provider Demographics
NPI:1346206216
Name:PALMETTO MEDICAL IMAGING
Entity Type:Organization
Organization Name:PALMETTO MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMUCLOVISKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-314-2505
Mailing Address - Street 1:2555 PONCE DE LEON BLVD 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-702-5135
Mailing Address - Fax:305-441-2144
Practice Address - Street 1:2001 WEST 68 STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-823-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38846Medicare PIN