Provider Demographics
NPI:1083667489
Name:UNIVERSAL DIAGNOSTIC, INC.
Entity type:Organization
Organization Name:UNIVERSAL DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFORENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-662-3000
Mailing Address - Street 1:5420 DASHWOOD DR
Mailing Address - Street 2:STE # 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5357
Mailing Address - Country:US
Mailing Address - Phone:713-662-3000
Mailing Address - Fax:713-662-3049
Practice Address - Street 1:5420 DASHWOOD DR
Practice Address - Street 2:STE # 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5357
Practice Address - Country:US
Practice Address - Phone:713-662-3000
Practice Address - Fax:713-662-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty