Organization
GREAT LAKES RADIOLOGISTS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS GROSSMAN (CHIEF OPERATING OFFICER)
(262) 780-0357
Entity
Organization
Contact information
Practice address
2875 S 171ST ST, NEW BERLIN, WI 53151-3200
(262) 786-3107
(262) 780-0442
Mailing address
PO BOX 511400, NEW BERLIN, WI 53151-3200
(262) 786-3107
(262) 780-0442
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32868800
—
WI
Enumeration date
07/10/2006
Last updated
08/22/2020
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