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General NPI Number Information
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NPI Number | 1023020062
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Entity Type | Organization
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Legal Business Name | COLUMBIA CARDIOGRAPHIC CONSULTANTS, LTD.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 2025 E NEWPORT AVE
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City | MILWAUKEE
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State | WI
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Zip | 53211-2906
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Country | US
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Telephone | 414-961-3300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1790
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City | BROOKFIELD
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State | WI
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Zip | 53008-1790
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Country | US
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Telephone | 888-850-0494
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Fax | 262-641-6893
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE WALCOTT
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Credential | M.D.
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Telephone | 414-961-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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