Organization
MOLECULAR IMAGING ALLIANCE OF MILWAUKEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE DOUGLAS (CONTRACT MANAGER)
(502) 403-1401
Entity
Organization
Contact information
Practice address
9200 LEESGATE RD STE 100, LOUISVILLE, KY 40222-5173
(502) 403-1401
(502) 403-1451
Mailing address
11226 W LAPHAM ST, WEST ALLIS, WI 53214-3806
(414) 395-1941
(414) 302-7064
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100015024
—
WI
Enumeration date
04/21/2010
Last updated
09/09/2011
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