Organization
RADIATION ONCOLOGY OF WISCONSIN S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL E OLSON M.D. (MEDICAL DIRECTOR)
(414) 291-1556
Entity
Organization
Contact information
Practice address
13111 N PORT WASHINGTON RD, ATTN: RADIATION ONCOLOGY DEPT., MEQUON, WI 53097-2416
(262) 243-8384
(920) 243-8385
Mailing address
PO BOX 1127, SHEBOYGAN, WI 53082-1127
(920) 457-6750
(920) 457-8350
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32896900
—
WI
01
—
CJ6385
TRAVELERS RR MEDICARE
WI
Enumeration date
02/26/2008
Last updated
04/20/2008
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