Organization
PALM DESERT RADIOLOGY MEDICAL GROUP, INC
Active
Other names
Eisenhower Radiology Medical Group, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEHRAN K. ELLY M.D. (PRESIDENT)
(760) 837-8449
Entity
Organization
Contact information
Practice address
39000 BOB HOPE DR, RANCHO MIRAGE, CA 92270
(760) 837-8449
(775) 624-9774
Mailing address
PO BOX 1629, EVANSVILLE, IN 47706-0030
(760) 837-8449
(760) 773-1848
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124079868
—
CA
01
—
CC9030
RR MEDICARE
CA
05
—
GR0012730
—
CA
01
—
ZZZ40340Z
BLUE SHIELD OF CA
CA
Enumeration date
05/15/2006
Last updated
02/05/2024
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