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Organization
MOLECULAR IMAGING ALLIANCE OF MILWAUKEE, LLC
Active
Organization
MOLECULAR IMAGING ALLIANCE OF MILWAUKEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE DOUGLAS (CONTRACT MANAGER)
(502) 403-1401
Entity
Organization
Contact information
Practice address
9200 LEESGATE RD STE 100, LOUISVILLE, KY 40222-5173
(502) 403-1401
(502) 403-1451
Mailing address
11226 W LAPHAM ST, WEST ALLIS, WI 53214-3806
(414) 395-1941
(414) 302-7064
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
NULL
Other
Enumeration date
04/21/2010
Last updated
09/09/2011
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