COMPREHENSIVE DIAGNOSTIC IMAGING OF WISCONSIN, LLC (NPI# 1255844106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255844106 |
| Entity Type | Organization |
| Organization Name | COMPREHENSIVE DIAGNOSTIC IMAGING OF WISCONSIN, LLC |
| Practice Address |
2500 W Layton Ave Ste 20 Milwaukee WI 53221-5400 |
| Practice Telephone | 2622619423 |
| Practice Fax Number | 4145394185 |
| Mailing Telephone | 2622619423 |
| Mailing Fax Number | 4145394185 |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2020-08-05 |
| Authorized Official Name | DR. JAMES MAZZULLA (MANAGING MEMBER) |
| Authorized Official Telephone | 4142812100 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| N | 261QM1200X |
Clinic/Center Specialization: Magnetic Resonance Imaging (MRI) |
Ambulatory Health Care Facilities | ||
| N | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities | ||
| N | 261QR0206X |
Clinic/Center Specialization: Radiology, Mammography |
Ambulatory Health Care Facilities | ||
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Street Address |
2500 W LAYTON AVE STE 20 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53221-5400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487205944 | Hayat Pharmacy 20 LLC | Pharmacy | 805 W. Layton Ave., Suite B, Milwaukee, WI 53221 | 2019-09-26 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1407343965 | Informe Healthcare LLC | Counselor | 2741 W Layton Ave., Suite 106, Milwaukee, WI 53221 | 2018-04-19 |
| 1447781992 | Itamar Yaakov Gnatt | Emergency Medicine | 2900 W Oklahoma Ave, St Lukes Medical Center, Milwaukee, WI 53221 | 2017-03-27 |
| 1194277160 | Suzanne Derosier | Licensed Practical Nurse | 3910 W Bridge, Greenfield, WI 53221 | 2016-10-26 |
| 1265988117 | Obi Home Care | Clinic/Center | 4439 S 20th St, Milwaukee, WI 53221 | 2016-08-31 |
| 1427430602 | Zezenya Health Care S.c. | Pain Medicine | 5114 S 27th St # 763, Milwaukee, WI 53221 | 2015-06-24 |
| 1851771091 | Feisal J Salahadyn | Counselor | 4800 South 10th Street, Milwaukee, WI 53221 | 2015-06-03 |
| 1114312386 | Holistic Home Health Care Incorporated | Adult Companion | 3422 West Howard Ave, Greenfield, WI 53221 | 2015-04-03 |
| 1841698834 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 5220 S 27th St., Milwaukee, WI 53221 | 2014-12-08 |
| Find all providers in zip 53221 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669814737 | Matthew William Shore | Radiology | 8915 W Connell Ave Dept Of, Milwaukee, WI 53226-3067 | 2013-07-18 |
| 1245538636 | Moira Ferrier Schieke | Radiology | 2542 N Terrace Ave, Milwaukee, WI 53211-3820 | 2011-03-09 |
| 1811127558 | Michael Orrin Griffin Jr. | Radiology | 9200 W. Wisconsin Ave., Department of Radiology, Milwaukee, WI 53226 | 2009-07-15 |
| 1598949026 | Deidre Meredith Rippl | Radiology | 2900 Oklahoma Ave, Milwaukee, WI 53215 | 2007-12-19 |
| 1053510115 | Petre Iosif Wecsler | Radiology | 7019 N Barnett Ln, Milwaukee, WI 53217-3606 | 2007-07-17 |
| 1285858019 | William Thomas Luckey | Radiology | 1545 W Spruce Ct, Milwaukee, WI 53217-1128 | 2007-04-12 |
| 1407957491 | Ferdinand M Brutvan | Radiology | 1925 E Iron St, Milwaukee, WI 53207-2315 | 2006-09-25 |
| 1295752251 | Sean R Amoli | Radiology | 6150 W Layton Ave, Milwaukee, WI 53220-4608 | 2006-07-16 |
| 1760416994 | Enhanced Medical Imaging Milwaukee LLC | Radiology | 7523 W Oklahoma Ave, Milwaukee, WI 53219-2861 | 2006-07-11 |
| 1396784948 | John Lammers | Radiology | 10400 W North Ave, Suite 300, Milwaukee, WI 53226-2425 | 2006-06-06 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.