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General NPI Number Information
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NPI Number | 1174551188
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Entity Type | Organization
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Legal Business Name | MILWAUKEE CENTER FOR DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1340A WEST TOWN SQUARE ROAD
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City | MEQUON
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State | WI
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Zip | 53092
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Country | US
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Telephone | 262-240-7226
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Fax | 262-240-7227
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Provider Business Mailing Address
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Address Line | PO BOX 2088 DEPT 4158
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City | MILWAUKEE
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State | WI
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Zip | 53201-2088
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Country | US
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Telephone | 952-542-8553
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Fax | 952-513-6880
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Authorized Official
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Title or Position | OFFICER ON THE BOARD ASST SECRETARY
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Name | DONALD D JACOBSEN
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Credential |
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Telephone | 952-543-6500
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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 |
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License Number State |
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