Organization
KENOSHA RADIOLOGY CENTER LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN S. PALLIN M.D. (PRESIDENT)
(262) 697-7770
Entity
Organization
Contact information
Practice address
10117 74TH ST, SUITE 150, KENOSHA, WI 53142-7533
(262) 697-7770
(262) 697-7771
Mailing address
10117 74TH ST, SUITE 150, KENOSHA, WI 53142-7533
(262) 697-7770
(262) 697-7771
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
XM310472
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21255800
—
WI
Enumeration date
04/28/2006
Last updated
08/22/2020
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