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General NPI Number Information
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NPI Number | 1053492611
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Entity Type | Organization
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Legal Business Name | M.R.DIAGNOSTIC AND IMAGING CENTER,INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6441 ENTERPRISE LN STE 211
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City | MADISON
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State | WI
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Zip | 53719-1156
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Country | US
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Telephone | 213-595-9545
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Fax |
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Provider Business Mailing Address
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Address Line | 6441 ENTERPRISE LN STE 211
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City | MADISON
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State | WI
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Zip | 53719-1156
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Country | US
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Telephone | 213-595-9545
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGUEL RUELAS
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Credential |
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Telephone | 213-595-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | WI
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