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General NPI Number Information
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NPI Number | 1225081292
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Entity Type | Organization
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Legal Business Name | RNA DIALYSIS OF MILWAUKEE
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5310 W CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53216-2239
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Country | US
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Telephone | 414-447-8592
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Fax | 414-447-8591
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Provider Business Mailing Address
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Address Line | 5310 W CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53216-2239
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Country | US
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Telephone | 414-447-8592
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Fax | 414-447-8591
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GORDON R LANG
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Credential | M.D.
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Telephone | 312-977-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | WI
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