# MOLECULAR IMAGING ALLIANCE OF MILWAUKEE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679890297
- **Authorized official:** MRS. MICHELLE DOUGLAS (CONTRACT MANAGER)
- **Authorized official phone:** (502) 403-1401

## Contact information

- **Practice address:** 9200 LEESGATE RD STE 100, LOUISVILLE, KY 40222-5173
- **Practice address phone:** (502) 403-1401
- **Practice address fax:** (502) 403-1451
- **Mailing address:** 11226 W LAPHAM ST, WEST ALLIS, WI 53214-3806
- **Mailing address phone:** (414) 395-1941
- **Mailing address fax:** (414) 302-7064

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/21/2010
- **Last updated:** 09/09/2011