Provider Demographics
NPI:1689897217
Name:DOUGLAS DIAGNOSTIC INC
Entity Type:Organization
Organization Name:DOUGLAS DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CIANCIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-275-6069
Mailing Address - Street 1:9485 SW 72ND ST
Mailing Address - Street 2:SUITE A150
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3242
Mailing Address - Country:US
Mailing Address - Phone:305-275-6069
Mailing Address - Fax:305-412-8265
Practice Address - Street 1:802 DOUGLAS ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-441-8800
Practice Address - Fax:305-445-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty