Provider Demographics
NPI:1619229473
Name:ICARE
Entity Type:Organization
Organization Name:ICARE
Other - Org Name:ICARE RADIOLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-202-2734
Mailing Address - Street 1:451 SW BETHANY DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1964
Mailing Address - Country:US
Mailing Address - Phone:772-202-2734
Mailing Address - Fax:
Practice Address - Street 1:451 SW BETHANY DR
Practice Address - Street 2:SUITE #102
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1964
Practice Address - Country:US
Practice Address - Phone:772-202-2734
Practice Address - Fax:772-249-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS107882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty