Provider Demographics
NPI:1760416994
Name:ENHANCED MEDICAL IMAGING MILWAUKEE LLC
Entity Type:Organization
Organization Name:ENHANCED MEDICAL IMAGING MILWAUKEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:WNUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-546-4450
Mailing Address - Street 1:520 58TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4115
Mailing Address - Country:US
Mailing Address - Phone:262-925-0990
Mailing Address - Fax:
Practice Address - Street 1:7523 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2861
Practice Address - Country:US
Practice Address - Phone:414-546-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21296700Medicaid
WI000092445Medicare PIN