Organization
PEDIATRIC RADIOLOGIC SERVICES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT G WELLS MD (OPERATING CHIEF)
(414) 266-1640
Entity
Organization
Contact information
Practice address
9000 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53201
(414) 266-1640
(414) 266-1625
Mailing address
PO BOX 230, ELM GROVE, WI 53122
(262) 821-9131
(262) 821-9132
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326-79000
—
WI
Enumeration date
05/09/2006
Last updated
08/22/2020
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