Provider Demographics
NPI:1376797274
Name:EXPERT DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:EXPERT DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:REVINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-691-0700
Mailing Address - Street 1:5001 MAYFIELD RD STE 317
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2608
Mailing Address - Country:US
Mailing Address - Phone:216-691-0700
Mailing Address - Fax:
Practice Address - Street 1:5001 MAYFIELD RD STE 317
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2608
Practice Address - Country:US
Practice Address - Phone:216-691-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty