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Organization

RADIATION ONCOLOGY OF WISCONSIN S C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONNA LARUE (OFFICE MANAGER)
(920) 457-6750
Entity
Organization

Contact information

Practice address
2350 N LAKE DR, RADIATION ONCOLOGY DEPT., MILWAUKEE, WI 53211-4507
(414) 291-1556
(414) 291-1557
Mailing address
PO BOX 1127, SHEBOYGAN, WI 53082-1127
(920) 457-6750
(920) 457-8350

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
2085R0203X
Therapeutic Radiology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32896900
WI
01
CJ6385
RAILROAD MEDICARE
WI
Enumeration date
11/03/2005
Last updated
04/20/2008
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