Healthcare Provider Details

I. General information

NPI: 1386661734
Provider Name (Legal Business Name): BELOIT RADIOLOGY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W HART RD
BELOIT WI
53511
US

IV. Provider business mailing address

2101 RIVERSIDE DR
BELOIT WI
53511
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-5269
  • Fax:
Mailing address:
  • Phone: 608-362-7888
  • Fax: 608-362-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateWI

VIII. Authorized Official

Name: JIMMY DADO
Title or Position: OFFICER
Credential: CFO
Phone: 614-325-8899