1467710772 NPI number — AFFILIATED MEDICAL IMAGING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467710772 NPI number — AFFILIATED MEDICAL IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED MEDICAL IMAGING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467710772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5310 W CAPITOL DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53216-2263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-727-1780
Provider Business Mailing Address Fax Number:
414-873-8632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5310 W CAPITOL DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53216-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-727-1780
Provider Business Practice Location Address Fax Number:
414-873-8632
Provider Enumeration Date:
04/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MANAGING OPERATOR
Authorized Official Telephone Number:
414-305-5200

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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