Provider Demographics
NPI:1982661070
Name:RADIOLOGICAL ASSOCIATES OF DULUTH, LTD
Entity Type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES OF DULUTH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUSLAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-722-3700
Mailing Address - Street 1:925 E SUPERIOR ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2238
Mailing Address - Country:US
Mailing Address - Phone:218-722-3700
Mailing Address - Fax:218-722-8705
Practice Address - Street 1:925 E SUPERIOR ST
Practice Address - Street 2:SUITE 109
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2238
Practice Address - Country:US
Practice Address - Phone:218-722-3700
Practice Address - Fax:218-722-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN78197RAOtherBLUE CROSS BLUE SHIELD
MN695210100Medicaid
MN78197RAOtherBLUE CROSS BLUE SHIELD