Organization
HALES CORNERS IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN SAGE (MEMBER MANAGER)
(630) 514-8503
Entity
Organization
Contact information
Practice address
11035 W FOREST HOME AVE, SUITE 103, HALES CORNERS, WI 53130-2541
(414) 425-6602
(414) 425-6604
Mailing address
11716 W GREENFIELD AVE, WEST ALLIS, WI 53214-2156
(414) 778-3866
(414) 778-3886
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21269000
—
WI
01
—
P00321327
RAIL ROAD PIN
—
Enumeration date
05/25/2006
Last updated
12/07/2007
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