Healthcare Provider Details

I. General information

NPI: 1982945010
Provider Name (Legal Business Name): HEART TO SOLE DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7635 WEST BLUEMOUND ROAD, SUITE 1C
MILWAUKEE WI
53213-3500
US

IV. Provider business mailing address

7635 WEST BLUEMOUND ROAD, SUITE 1C
MILWAUKEE WI
53213-3500
US

V. Phone/Fax

Practice location:
  • Phone: 414-935-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. NINEF AGHAKHAN
Title or Position: DIRECTOR
Credential:
Phone: 414-935-4545