Provider Demographics
NPI:1467710772
Name:AFFILIATED MEDICAL IMAGING
Entity Type:Organization
Organization Name:AFFILIATED MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-305-5200
Mailing Address - Street 1:5310 W CAPITOL DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2263
Mailing Address - Country:US
Mailing Address - Phone:414-727-1780
Mailing Address - Fax:414-873-8632
Practice Address - Street 1:5310 W CAPITOL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2263
Practice Address - Country:US
Practice Address - Phone:414-727-1780
Practice Address - Fax:414-873-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology