Provider Demographics
NPI:1295917003
Name:RADIOLOGY CONSULTANTS OF WISCONSIN SC
Entity type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF WISCONSIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-391-5000
Mailing Address - Street 1:N4W22370 BLUEMOUND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1683
Mailing Address - Country:US
Mailing Address - Phone:262-349-9371
Mailing Address - Fax:262-408-5258
Practice Address - Street 1:N4W22370 BLUEMOUND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1683
Practice Address - Country:US
Practice Address - Phone:262-349-9371
Practice Address - Fax:262-408-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21320900Medicaid
WI21320900Medicaid