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General NPI Number Information
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NPI Number | 1174054670
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD LARSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | UW HOSPITALS & CLINICS 600 HIGHLAND AVE
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City | MADISON
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State | WI
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Zip | 53792
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Country | US
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Telephone | 262-893-0613
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Fax |
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Provider Business Mailing Address
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Address Line | RADIOLOGY WAUKESHA, S.C. 1336 PARK AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-1133
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Country | US
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Telephone | 414-940-0278
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Fax | 414-301-9508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 71888-20
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License Number State | WI
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