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General NPI Number Information
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NPI Number | 1932109675
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Entity Type | Organization
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Legal Business Name | WISCONSIN DIAGNOSTIC LABORATORIES LLC
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-7699
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 78055
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City | MILWAUKEE
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State | WI
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Zip | 53278-8055
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Country | US
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Telephone | 414-805-7680
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Fax | 414-805-7514
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Authorized Official
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Title or Position | CFO
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Name | ROBIN HERBNER
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Credential |
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Telephone | 414-805-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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