Provider Demographics
NPI:1295752251
Name:AMOLI, SEAN R (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:AMOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 W LAYTON AVE
Mailing Address - Street 2:P. O. BOX 20859
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4608
Mailing Address - Country:US
Mailing Address - Phone:414-914-9430
Mailing Address - Fax:414-914-9444
Practice Address - Street 1:6150 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-4608
Practice Address - Country:US
Practice Address - Phone:414-914-9430
Practice Address - Fax:414-914-9444
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI396392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32547100Medicaid
WI921150001Medicare ID - Type Unspecified
WI32547100Medicaid