Provider Demographics
NPI:1205894235
Name:NORTHGATE MEDICAL IMAGING LLC
Entity type:Organization
Organization Name:NORTHGATE MEDICAL IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-949-0807
Mailing Address - Street 1:807 NORTHGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6419
Mailing Address - Country:US
Mailing Address - Phone:812-949-0807
Mailing Address - Fax:812-949-0806
Practice Address - Street 1:807 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6419
Practice Address - Country:US
Practice Address - Phone:812-949-0807
Practice Address - Fax:812-949-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233030Medicare Oscar/Certification