Mark David Imwalle, MD | |
3000 Mack Rd, Fairfield, OH 45014-5335 | |
(513) 870-7024 | |
(513) 965-8091 |
Full Name | Mark David Imwalle |
---|---|
Gender | Male |
Speciality | Radiology - Diagnostic Radiology |
Location | 3000 Mack Rd, Fairfield, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1740284538 | NPI | - | NPPES |
0349644 | Medicaid | OH | |
64781099 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2085R0202X | Radiology - Diagnostic Radiology | 35031812I (Ohio) | Primary |
Entity Name | Proscan Radiology, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1588654610 PECOS PAC ID: 5799680807 Enrollment ID: O20031203000127 |
Mailing Address | Practice Location Address |
---|---|
Mark David Imwalle, MD Po Box 42417, Cincinnati, OH 45242-0417 Ph: (513) 965-8041 | Mark David Imwalle, MD 3000 Mack Rd, Fairfield, OH 45014-5335 Ph: (513) 870-7024 |
Dr. Michael A Cross, MD Radiology Medicare: Medicare Enrolled Practice Location: 2960 Mack Rd Ste 105, Fairfield, OH 45014 Phone: 513-751-2273 Fax: 513-751-1840 | |
Bradford Harold Woodall, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3000 Mack Rd, Fairfield, OH 45014 Phone: 513-870-7024 Fax: 513-965-8091 | |
Robert A Love Iii, MD Radiology Medicare: Medicare Enrolled Practice Location: 3000 Mack Rd, Fairfield, OH 45014 Phone: 513-870-7024 Fax: 513-965-8091 | |
Donald Kolman Imwalle, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3000 Mack Rd, Fairfield, OH 45014 Phone: 513-965-8041 Fax: 513-965-8091 | |
Jeffrey I Grass, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 2960 Mack Rd Ste 105, Fairfield, OH 45014 Phone: 513-751-2273 | |
Susan Marie Cha, MD Radiology Medicare: Medicare Enrolled Practice Location: 3000 Mack Rd, Fairfield, OH 45014 Phone: 513-870-7024 Fax: 513-965-8091 | |
Timothy Joseph Phalen, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3000 Mack Rd, Fairfield, OH 45014 Phone: 513-870-7024 Fax: 513-965-8091 |