Alliance Telemed LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

01056877 Issued in IN

Legal business name

ALLIANCE TELEMED LLC

Practice address

2600 S Henderson St
Suite 122
Bloomington, IN 47401-8439

Phone

(812) 320-7229

NPI assigned

Oct 25, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ayman A Ghoniem, MD

Title

Sole Member

Phone

(812) 320-7229

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353801600000",
    "number": "1730489790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S HENDERSON ST",
            "address_2": "SUITE 122",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018439",
            "telephone_number": "812-320-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S HENDERSON ST",
            "address_2": "SUITE 122",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018439",
            "telephone_number": "812-320-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE TELEMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-25",
        "last_updated": "2012-11-25",
        "status": "A",
        "authorized_official_last_name": "GHONIEM",
        "authorized_official_first_name": "AYMAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "812-320-7229",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01056877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.