Organization
BREAST DIAGNOSTIC CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R MILBRATH (PRESIDENT)
(262) 523-4800
Entity
Organization
Contact information
Practice address
W238 N1645 ROCKWOOD DRIVE, STE 100, WAUKESHA, WI 53188-1148
(262) 523-4800
(262) 523-4805
Mailing address
W238 N1645 ROCKWOOD DRIVE, STE 100, WAUKESHA, WI 53188-1148
(262) 523-4800
(262) 523-4805
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104257
FDA CERTIFICATION
WI
05
—
32691200
—
WI
Enumeration date
05/09/2007
Last updated
08/22/2020
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