Provider Demographics
NPI:1780815209
Name:SPECTRUM DIAGNOSTIC IMAGING OF OHIO LLC
Entity Type:Organization
Organization Name:SPECTRUM DIAGNOSTIC IMAGING OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-584-2900
Mailing Address - Street 1:4400 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2168
Mailing Address - Country:US
Mailing Address - Phone:216-584-2900
Mailing Address - Fax:216-584-2901
Practice Address - Street 1:8401 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5842
Practice Address - Country:US
Practice Address - Phone:440-205-1730
Practice Address - Fax:440-205-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty