MEDICARE: RNA DIALYSIS OF MILWAUKEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		WI

General Provider Information

NPI Number	:	1225081292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RNA DIALYSIS OF MILWAUKEE

Provider Business Mailing Address
First Line	:	5310 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2239
Country	:	US
Telephone Number	:	414-447-8592
Fax Number	:	414-447-8591

Provider Business Practice Location Address
First Line	:	5310 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2239
Country	:	US
Telephone Number	:	414-447-8592
Fax Number	:	414-447-8591

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. GORDON R LANG
Credential	:	M.D.
Telephone Number	:	312-977-0900

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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