RADIATION ONCOLOGY OF WISCONSIN S C (NPI# 1740271287) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740271287 |
| Entity Type | Organization |
| Organization Name | RADIATION ONCOLOGY OF WISCONSIN S C |
| Practice Address |
2350 N Lake Dr Radiation Oncology Dept. Milwaukee WI 53211-4507 |
| Mailing Address |
Po Box 1127 Sheboygan WI 53082-1127 |
| Practice Telephone | 4142911556 |
| Practice Fax Number | 4142911557 |
| Mailing Telephone | 9204576750 |
| Mailing Fax Number | 9204578350 |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | DONNA LARUE (OFFICE MANAGER) |
| Authorized Official Telephone | 9204576750 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0203X |
Radiology Specialization: Therapeutic Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | RAILROAD MEDICARE | CJ6385 | 01 |
| WI | 32896900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164691986 | Radiation Oncology of Wisconsin S C | Radiology | 13111 N Port Washington Rd, Attn: Radiation Oncology Dept., Mequon, WI 53097-2416 | 2008-02-26 |
| Street Address |
2350 N LAKE DR RADIATION ONCOLOGY DEPT. |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53211-4507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194721407 | Nguyen H Phan | Internal Medicine | 2350 N Lake Dr, Ste 206, Milwaukee, WI 53211-4528 | 2005-06-22 |
| 1326650698 | Dylan Henry Menefee | Physician Assistant | 2350 N Lake Dr, Milwaukee, WI 53211-4528 | 2020-08-18 |
| 1659936169 | Cadie Leigh Roszak | Nurse Practitioner | 2350 N Lake Dr, Milwaukee, WI 53211-4528 | 2019-05-09 |
| 1457884165 | Shelly A. Boyd | Nurse Practitioner | 2350 N Lake Dr, Suite 302, Milwaukee, WI 53211-4528 | 2017-04-10 |
| 1043663818 | Kelly Brock | Physician Assistant | 2350 N Lake Dr, Suite 206, Milwaukee, WI 53211-4528 | 2016-07-18 |
| 1376996397 | Jennifer Gallagher | Physician Assistant | 2350 N Lake Dr, Suite 206, Milwaukee, WI 53211-4528 | 2016-07-14 |
| 1104285873 | Catherine Bares | Nurse Practitioner | 2350 N Lake Dr, Suite 100, Milwaukee, WI 53211-4528 | 2016-02-23 |
| 1578921375 | Heather Bastjan | Nurse Practitioner | 2350 N Lake Dr, Suite 500, Milwaukee, WI 53211-4528 | 2016-02-08 |
| 1033586292 | Angela Kraus | Nurse Practitioner | 2350 N Lake Dr, Suite 302, Milwaukee, WI 53211-4528 | 2015-08-24 |
| 1871974964 | Tatyana Trendafilova Radulovic | Nurse Practitioner | 2350 N Lake Dr, Suite 302, Milwaukee, WI 53211-4528 | 2015-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821602335 | Gabriella Caitrin Emanuele | Occupational Therapist | Harborchase of Shorewood, 1111 E Capitol Drive, Shorewood, WI 53211 | 2020-09-02 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1861043952 | Rosina Bloomingdale Norton | Nurse Practitioner | 1921 E Harford Ave, Milwaukee, WI 53211 | 2019-09-20 |
| 1528556255 | Renee Reckelberg | Specialist/Technologist | 3409 North Downer Avenue, Pavilion, Suite 350, Milwaukee, WI 53211 | 2018-04-27 |
| 1700325602 | Wisconsin Vision, Inc. | Optometrist | 4163 N Oakland Ave, Shorewood, WI 53211 | 2017-02-13 |
| 1750827556 | Daniel Butz M.d., S.c. | Plastic Surgery | 2350 N Lake Dr Ste 304, Milwaukee, WI 53211 | 2017-01-17 |
| 1528517232 | Therese Simonis | Speech-Language Pathologist | 2390 N Lake Drive, Milwaukee, WI 53211 | 2016-09-23 |
| 1982075701 | Katie Michel | Specialist/Technologist | 3409 N. Downer Ave, Milwaukee, WI 53211 | 2015-10-20 |
| 1255776365 | Sarah Elizabeth Brill | Social Worker | 4433 N Oakland Ave Ste D, Shorewood, WI 53211 | 2013-05-02 |
| 1679814537 | Nicole Anne Parulski | Physical Therapist | 2301 North Lake Dr, Milwaukee, WI 53211 | 2013-03-01 |
| Find all providers in zip 53211 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| 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 Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861924482 | Katie Johannah Livingston | Radiology | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2017-04-02 |
| 1891157871 | Jacob Samuel Witt | Radiology | 2900 W Oklahoma Ave, Milwaukee, WI 53215-4330 | 2016-03-28 |
| 1679935860 | Amber Ann Retzlaff | Radiology | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2016-03-25 |
| 1912384280 | Saryleine Ortiz De Choudens | Radiology | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2015-05-06 |
| 1396131439 | Nina A Desai | Radiology | 8701 W Watertown Plank Rd, Milwaukee, WI 53226 | 2015-04-14 |
| 1124413422 | Daniel Paul Lindsay | Radiology | 2900 W Oklahoma Ave, Milwaukee, WI 53215-4330 | 2015-04-02 |
| 1205279957 | Musaddiq Javvad Awan | Radiology | 9200 W Wisconsin Ave, Milwaukee, WI 53226 | 2013-04-12 |
| 1699038588 | Lindsay L Puckett | Radiology | 9200 W Wisconsin Ave, Milwaukee, WI 53226 | 2012-06-17 |
| 1265708606 | Hina Saeed | Radiology | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2012-03-29 |
| 1801188230 | Jeffrey Alan Kittel | Radiology | 2900 W Oklahoma Ave, Milwaukee, WI 53215-4330 | 2011-05-03 |
| Find all providers in MILWAUKEE | ||||
Please comment or provide details below to improve the information on RADIATION ONCOLOGY OF WISCONSIN S C.
| 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.