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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