Provider Demographics
NPI:1669857348
Name:M2 D2 LLC
Entity type:Organization
Organization Name:M2 D2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-990-8134
Mailing Address - Street 1:5353 N. FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3236
Mailing Address - Country:US
Mailing Address - Phone:954-990-8134
Mailing Address - Fax:954-990-8634
Practice Address - Street 1:2137 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2242
Practice Address - Country:US
Practice Address - Phone:800-590-9674
Practice Address - Fax:859-757-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G476023Medicare PIN