Organization
LAKESIDE DIAGNOSTIC IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE W. CARDONE MD (AUTHORIZED OFFICIAL)
(414) 964-4601
Entity
Organization
Contact information
Practice address
4601 N OAKLAND AVE, SHOREWOOD, WI 53211-1232
(414) 964-4601
(414) 964-4616
Mailing address
4601 N OAKLAND AVE, SHOREWOOD, WI 53211-1232
(414) 964-4601
(414) 964-4616
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21258300
—
WI
Enumeration date
06/12/2006
Last updated
03/25/2008
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