Organization
PROACTIVE IMAGING LLC
Active
Other names
Minnesota Radiology
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL L SOTO PRESIDENT (PRESIDENT)
(954) 559-2421
Entity
Organization
Contact information
Practice address
4000 W 76TH ST, STE 100, EDINA, MN 55435-5104
(952) 853-7226
(952) 831-7555
Mailing address
4000 W 76TH ST, STE 100, EDINA, MN 55435-5104
(952) 853-7226
(952) 831-7555
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
540
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22030077
OFFICE OF WORK COMP.
MN
01
—
P00053758
MEDICARE RAILROAD
MN
Enumeration date
05/31/2005
Last updated
10/02/2008
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