Organization
CT IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES A DIETSCHE (CFO)
(920) 433-3796
Entity
Organization
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301
(920) 433-3411
(920) 499-5808
Mailing address
PO BOX 33164, GREEN BAY, WI 54303
(920) 499-1428
(920) 499-5808
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21267900
—
WI
01
—
DA1841
RR MEDICARE
—
Enumeration date
07/11/2006
Last updated
08/22/2020
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