Provider Demographics
NPI:1124550405
Name:RADIOLOGY CONSULTANTS OF WISCONSIN
Entity Type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-349-9371
Mailing Address - Street 1:N4W22370 BLUEMOUND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1683
Mailing Address - Country:US
Mailing Address - Phone:262-349-9371
Mailing Address - Fax:262-408-5258
Practice Address - Street 1:1239 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4898
Practice Address - Country:US
Practice Address - Phone:262-569-8346
Practice Address - Fax:262-567-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty