Provider Demographics
NPI:1710152079
Name:STIENNON RADIOLOGY GROUP
Entity Type:Organization
Organization Name:STIENNON RADIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STIENNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-233-8957
Mailing Address - Street 1:2814 MARSHALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2258
Mailing Address - Country:US
Mailing Address - Phone:608-233-8957
Mailing Address - Fax:608-233-1964
Practice Address - Street 1:2814 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2258
Practice Address - Country:US
Practice Address - Phone:608-233-8957
Practice Address - Fax:608-233-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32703500Medicaid
WI32703500Medicaid