Provider Demographics
NPI:1629004098
Name:CENTRAL WISCONSIN RADIOLOGISTS SC
Entity Type:Organization
Organization Name:CENTRAL WISCONSIN RADIOLOGISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUNAGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-344-1234
Mailing Address - Street 1:3410 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1325
Mailing Address - Country:US
Mailing Address - Phone:715-344-1234
Mailing Address - Fax:715-344-6367
Practice Address - Street 1:3410 STANLEY ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1325
Practice Address - Country:US
Practice Address - Phone:715-344-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32730300Medicaid
WI32730300Medicaid
WI32730300Medicaid