Provider Demographics
NPI:1699956391
Name:RADIOLOGICAL ASSOCIATES OF DULUTH
Entity type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES OF DULUTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUSLAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-722-3700
Mailing Address - Street 1:1101 E 37TH ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2971
Mailing Address - Country:US
Mailing Address - Phone:218-312-1200
Mailing Address - Fax:218-312-1201
Practice Address - Street 1:1101 E 37TH ST
Practice Address - Street 2:SUITE 30
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2971
Practice Address - Country:US
Practice Address - Phone:218-312-1200
Practice Address - Fax:218-312-1201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGICAL ASSOCIATES OF DULUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN695210100Medicaid
MN470000063Medicare PIN