Healthcare Provider Details

I. General information

NPI: 1326058645
Provider Name (Legal Business Name): SMART CHOICE MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 MILLER PARK WAY
WEST MILWAUKEE WI
53214-3605
US

IV. Provider business mailing address

10532 NORTH PORT WASHINGTON ROAD SUITE 1B
MEGQUON WI
53092
US

V. Phone/Fax

Practice location:
  • Phone: 414-431-0309
  • Fax: 414-672-2292
Mailing address:
  • Phone: 414-431-0309
  • Fax: 414-672-2292

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: CHRISTINE M HERBST
Title or Position: VP, OPERATIONS
Credential:
Phone: 414-807-5733