Organization
COMPREHENSIVE DIAGNOSTIC IMAGING OF WISCONSIN, LLC
Active
Organization
COMPREHENSIVE DIAGNOSTIC IMAGING OF WISCONSIN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MAZZULLA MD (MANAGING MEMBER)
(414) 281-2100
Entity
Organization
Contact information
Practice address
2500 W LAYTON AVE STE 20, MILWAUKEE, WI 53221-5400
(262) 261-9423
(414) 539-4185
Mailing address
2500 W LAYTON AVE STE 20, MILWAUKEE, WI 53221-5400
(262) 261-9423
(414) 539-4185
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Enumeration date
11/14/2017
Last updated
08/05/2020
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