Organization
RADIOLOGY REGIONAL CENTER PROFESSIONAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN A KRIVISKY MD (PRESIDENT)
(239) 931-6376
Entity
Organization
Contact information
Practice address
13681 DOCTORS WAY, FORT MYERS, FL 33912-4300
(239) 343-1000
Mailing address
3660 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
12/24/2014
Last updated
06/18/2020
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