Individual
AMANDA ROSE SMOLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
61428-20
WI
2085R0204X
Vascular & Interventional Radiology Physician
Primary
61428
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255699682
—
WI
Enumeration date
04/23/2012
Last updated
11/21/2023
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