1760416994 NPI number — ENHANCED MEDICAL IMAGING MILWAUKEE LLC

Table of content: (NPI 1760416994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760416994 NPI number — ENHANCED MEDICAL IMAGING MILWAUKEE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENHANCED MEDICAL IMAGING MILWAUKEE LLC
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:
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NPI Number Information

NPI Number:
1760416994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 58TH ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53140-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-925-0990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7523 W OKLAHOMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53219-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-546-4450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WNUCK
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-546-4450

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21296700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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