MEDICARE: MILWAUKEE IMAGING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471S1302X	Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1417216912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILWAUKEE IMAGING, INC.

Provider Business Mailing Address
First Line	:	251 MILWAUKEE AVE
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2809
Country	:	US
Telephone Number	:	847-675-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 MILWAUKEE AVE
Second Line	:	1015
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2809
Country	:	US
Telephone Number	:	847-675-5292
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OMAR GARCIA
Credential	:	M.D.
Telephone Number	:	847-675-5292

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/04/2012

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