Organization
DIAGNOSTIC RADIOLOGIC IMAGING PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI J SPARTZ (ADMINISTRATOR)
(507) 372-2120
Entity
Organization
Contact information
Practice address
1607 N MCMILLAN ST, STE 1, WORTHINGTON, MN 56187
(507) 372-2120
(507) 372-4585
Mailing address
PO BOX 338, WORTHINGTON, MN 56187
(507) 372-2120
(507) 372-4585
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
545
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144287
—
IA
Enumeration date
07/17/2006
Last updated
08/22/2020
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