Healthcare Provider Details

I. General information

NPI: 1679507883
Provider Name (Legal Business Name): CENTER FOR MEDICAL IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W178N9912 RIVERCREST DR SUITE 102
GERMANTOWN WI
53022-4645
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-4500
  • Fax: 262-255-6500
Mailing address:
  • Phone: 414-423-4100
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateWI

VIII. Authorized Official

Name: DR. ROGER PELLMANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-255-4500