Basic Information
| Provider Information | |||||||||
| NPI: | 1780656876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL DIAGNOSTIC IMAGING GROUP LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 97641 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891937641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448579797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10835 N 25TH AVE STE 240 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850293458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022462584 | ||||||||
| FaxNumber: | 6022462566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | SADEGI | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8448579797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.