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General NPI Number Information
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NPI Number | 1003276841
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL DIAGNOSTIC SERVICES LLC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 5205 S 13TH ST UNIT E
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City | MILWAUKEE
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State | WI
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Zip | 53221-3648
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Country | US
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Telephone | 414-477-3398
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Fax |
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Provider Business Mailing Address
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Address Line | 5205 S 13TH ST UNIT E
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City | MILWAUKEE
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State | WI
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Zip | 53221-3648
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Country | US
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Telephone | 414-477-3398
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KUTAIBA AL ITHAWI
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Credential |
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Telephone | 414-477-3398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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