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General NPI Number Information
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NPI Number | 1164691986
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Entity Type | Organization
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Legal Business Name | RADIATION ONCOLOGY OF WISCONSIN S C
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 13111 N PORT WASHINGTON RD ATTN: RADIATION ONCOLOGY DEPT.
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City | MEQUON
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State | WI
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Zip | 53097-2416
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Country | US
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Telephone | 262-243-8384
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Fax | 920-243-8385
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Provider Business Mailing Address
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Address Line | PO BOX 1127
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City | SHEBOYGAN
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State | WI
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Zip | 53082-1127
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Country | US
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Telephone | 920-457-6750
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Fax | 920-457-8350
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CARL E OLSON
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Credential | M.D.
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Telephone | 414-291-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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