Organization
RADIOLOGY CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANIECE BRABANT (OFFICE MANAGER)
(920) 499-2766
Entity
Organization
Contact information
Practice address
1789 SHAWANO AVE, GREEN BAY, WI 54303-3243
(920) 499-1428
(920) 499-7080
Mailing address
1789 SHAWANO AVE, GREEN BAY, WI 54303-3243
(920) 499-1428
(920) 499-7080
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007273
PTAN
WI
05
—
32725000
—
WI
01
—
C04047
RR MEDICARE
WI
Enumeration date
07/11/2006
Last updated
06/15/2023
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