Active NPI
Ihc-Kenosha Radiology, LLC
- Diagnostic Radiology Physician
- Kenosha, WI
National Provider Identifier
1285683284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- IHC-KENOSHA RADIOLOGY, LLC
- Practice address
- 6308 8TH Avenue
Uhs Kenosha Campus
Kenosha, WI 53143-5031 - Phone
- (414) 290-6720
- Fax
- (414) 290-6755
- NPI assigned
- May 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathleen Kondas
- Title
- Officer
- Phone
- (954) 838-2371
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
6308 8TH Avenue
Uhs Kenosha Campus
Kenosha, WI 53143-5031
Mailing address
111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815
Phone (414) 290-6720
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CG5950 | Other | WI | MEDICARE RAILROAD |
| 120005850 | Other | WI | WEA |
| 020447700 | Other | WI | FEDERAL BLACK LUNG PROGRA |
| 125363400 | Other | WI | OWCP |
| 32881400 | Medicaid | WI |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1568592000000",
"number": "1285683284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 E WISCONSIN AVE",
"address_2": "SUITE 2000",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532024815",
"telephone_number": "414-290-6720",
"fax_number": "414-290-6755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6308 8TH AVENUE",
"address_2": "UHS KENOSHA CAMPUS",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435031",
"telephone_number": "414-290-6720",
"fax_number": "414-290-6755"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IHC-KENOSHA RADIOLOGY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-08",
"last_updated": "2019-09-16",
"status": "A",
"authorized_official_last_name": "KONDAS",
"authorized_official_first_name": "KATHLEEN",
"authorized_official_title_or_position": "OFFICER",
"authorized_official_telephone_number": "954-838-2371"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "CG5950",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WEA",
"identifier": "120005850",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG PROGRA",
"identifier": "020447700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "125363400",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32881400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.