Provider Demographics
NPI:1699232223
Name:INDEAL LLC
Entity type:Organization
Organization Name:INDEAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-690-6360
Mailing Address - Street 1:1192 BEMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5715
Mailing Address - Country:US
Mailing Address - Phone:248-690-6360
Mailing Address - Fax:
Practice Address - Street 1:1192 BEMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5715
Practice Address - Country:US
Practice Address - Phone:248-690-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier