| Organization Name: | INSTITUTE OF DIAGNOSTIC IMAGING,LLC |
| NPI Number: | 1982670022 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURIE BORGSTROM (OFFICE MANAGER) |
| Mailing Address: | 424 Racetrack Rd Nw Ft Walton Beach |
| State: | FL US |
| Postal Code: | 325471556 |
| Phone Number: | 8503147575 |
| Fax Number: | 8503147494 |
| NPI Enumeration Date: | 02/28/2006 |
| NPI Last Update Date: | 06/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 602617 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |