Provider Demographics
NPI:1215991815
Name:ADVANCED IMAGING CONCEPTS PL
Entity type:Organization
Organization Name:ADVANCED IMAGING CONCEPTS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIKKISANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-0016
Mailing Address - Street 1:13470 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6820
Mailing Address - Country:US
Mailing Address - Phone:352-597-0016
Mailing Address - Fax:352-597-0089
Practice Address - Street 1:13470 TAFT ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6820
Practice Address - Country:US
Practice Address - Phone:352-597-0016
Practice Address - Fax:352-597-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112355300Medicaid
FL272239900Medicaid