Healthcare Provider Details

I. General information

NPI: 1124550405
Provider Name (Legal Business Name): RADIOLOGY CONSULTANTS OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 CORPORATE CENTER DR
OCONOMOWOC WI
53066-4898
US

IV. Provider business mailing address

N4W22370 BLUEMOUND RD SUITE 201
WAUKESHA WI
53186-1683
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-8346
  • Fax: 262-567-8480
Mailing address:
  • Phone: 262-349-9371
  • Fax: 262-408-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRUCE WILLIAM CARDONE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 262-349-9371