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General NPI Number Information
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NPI Number | 1861685133
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Entity Type | Organization
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Legal Business Name | RADIOLOGY WAUKESHA S.C.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 125 HOSPITAL DR
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City | WATERTOWN
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State | WI
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Zip | 53098-3303
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Country | US
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Telephone | 920-262-4659
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Fax | 414-422-9620
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Provider Business Mailing Address
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Address Line | 18650 W CORPORATE DR SUITE 200
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City | BROOKFIELD
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State | WI
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Zip | 53045-6344
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Country | US
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Telephone | 262-641-6888
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Fax | 414-422-9620
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. VICTOR IAN CZARNECKI
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Credential | MBA
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Telephone | 414-422-0780
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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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