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General NPI Number Information
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NPI Number | 1770760480
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Entity Type | Organization
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Legal Business Name | CARDIAC DIAGNOSTIC CLINIC, LTD
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 2500 W LAYTON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53221-5420
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Country | US
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Telephone | 262-251-8447
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Fax | 262-251-5193
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Provider Business Mailing Address
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Address Line | PO BOX 210918
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City | MILWAUKEE
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State | WI
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Zip | 53221-8016
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Country | US
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Telephone | 262-251-8447
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Fax | 262-251-5193
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. MARILYN ANN MARCHESE
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Credential |
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Telephone | 262-251-8447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 23216
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License Number State | WI
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