Individual
BRIDGET K LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2000 E LAYTON AVE, ST FRANCIS, WI 53235-6053
(414) 744-6589
(414) 747-8848
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
61622
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063149
—
WI
05
—
1285993725
—
WI
Enumeration date
05/03/2012
Last updated
10/09/2023
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