Wisconsin Diagnostic Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

WISCONSIN DIAGNOSTIC LABORATORIES LLC

Practice address

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522

Phone

(414) 805-7699

NPI assigned

Jul 22, 2005

Last updated

Nov 19, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robin Herbner

Title

Cfo

Phone

(414) 805-7793

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ezedin M Sadeghi, D.D.S.

  • Oral and Maxillofacial Pathology Dentistry
  • Fox Point, WI
  • NPI 1225191067
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1932109675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78055",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788055",
            "telephone_number": "414-805-7680",
            "fax_number": "414-805-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DIAGNOSTIC LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "HERBNER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "414-805-7793"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32921300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wisconsin Dental Group, S.C. (ForwardDental RiverCenter)
• Wisconsin Dental Group, S.C. (ForwardDental Bay View)
• Wisconsin Dental Group, S.C. (ForwardDental Brown Deer)
• Wisconsin Dental Group, S.C. (ForwardDental Forest Home)
• Wisconsin Dental Group,S.C. (Forward Dental)
• Wisconsin Doulas of Color Collective Inc
• Wisconsin Endodontics SC
• Wisconsin Family Services
• Wisconsin Geriatric Psychological Services SC
• Wisconsin Health Fund

• Clinical Medical Laboratory in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Medical Laboratory in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.