Basic Information
| Provider Information | |||||||||
| NPI: | 1659874840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MDIG TELERADIOLOGY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10835 N 25TH AVE | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850294751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022462584 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10835 N 25TH AVE STE 240 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850293458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022462584 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2018 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | INGUI | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MBR | ||||||||
| AuthorizedOfficialTelephone: | 6022462584 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.