52D2006919 CLIA NUMBER - MEDICAL DIAGNOSTIC IMAGING

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Laboratory Demographics

CLIA Number: 52D2006919

Facility Name: MEDICAL DIAGNOSTIC IMAGING

Facility Address:
3077 N MAYFAIR ROAD SUITE 115
WAUWATOSA, WI
ZIP 53222
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Facility Phone Number: 414 847-1800

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1427165331

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	52D2006919
LAB Type	Practitioner Other
Facility Name	MEDICAL DIAGNOSTIC IMAGING
Street	3077 N MAYFAIR ROAD SUITE 115
City	WAUWATOSA
State	WI
ZIP	53222
Phone	414 847-1800
CertificateType	4
CertificateEffectiveDate	5/4/2024
CertificateExpirationDate	5/3/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024