Healthcare Provider Details

I. General information

NPI: 1538127816
Provider Name (Legal Business Name): MRI & IMAGING OF WISCONSIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 75TH ST SUITE 106
KENOSHA WI
53142-8213
US

IV. Provider business mailing address

PO BOX 934978
ATLANTA GA
31193-4978
US

V. Phone/Fax

Practice location:
  • Phone: 262-697-9800
  • Fax: 262-697-8450
Mailing address:
  • Phone: 866-659-1211
  • Fax: 336-774-1751

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: MR. DANIEL J SCHAEFER
Title or Position: COO
Credential:
Phone: 770-300-0101