Provider Demographics
NPI:1225081292
Name:RNA DIALYSIS OF MILWAUKEE
Entity Type:Organization
Organization Name:RNA DIALYSIS OF MILWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-977-0900
Mailing Address - Street 1:5310 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2239
Mailing Address - Country:US
Mailing Address - Phone:414-447-8592
Mailing Address - Fax:414-447-8591
Practice Address - Street 1:5310 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2239
Practice Address - Country:US
Practice Address - Phone:414-447-8592
Practice Address - Fax:414-447-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI522567Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER