Organization
RADIOLOGY REGIONAL CENTER, PA
Active
Organization
RADIOLOGY REGIONAL CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN A KRIVISKY MD (CEO)
(239) 936-2316
Entity
Organization
Contact information
Practice address
9776 BONITA BEACH RD SE STE 100, BONITA SPRINGS, FL 34135-4773
(239) 444-2200
(239) 444-2210
Mailing address
3660 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
(239) 834-6106
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054636414
—
FL
Enumeration date
08/20/2021
Last updated
08/20/2021
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