Organization
PEDIATRIC DIAGNOSTIC IMAGING, S.C.
Active
Other names
PDI
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT G WELLS M.D. (PRESIDENT)
(414) 847-1800
Entity
Organization
Contact information
Practice address
8522 W CAPITOL DR, MILWAUKEE, WI 53222-1827
(414) 847-1800
(414) 847-1820
Mailing address
8522 W CAPITOL DR, MILWAUKEE, WI 53222-1827
(414) 847-1800
(414) 847-1820
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
23901-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21286500
—
WI
Enumeration date
08/12/2006
Last updated
03/11/2009
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