Organization
IHC-KENOSHA RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN KONDAS (OFFICER)
(954) 838-2371
Entity
Organization
Contact information
Practice address
6308 8TH AVENUE, UHS KENOSHA CAMPUS, KENOSHA, WI 53143-5031
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020447700
FEDERAL BLACK LUNG PROGRA
WI
01
—
120005850
WEA
WI
01
—
125363400
OWCP
WI
05
—
32881400
—
WI
01
—
CG5950
MEDICARE RAILROAD
WI
Enumeration date
05/08/2006
Last updated
09/16/2019
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