Axtell, Roger
Axtell, Roger is an individual health care provider with primary practice located at 2875 S 171St St , New Berlin WI 53151-3511. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Axtell, Roger can be contacted via phone (262) 786-3107.Contact Information
Primary practice address
2875 S 171St St
New Berlin WI 53151-3511
Phone: (262) 786-3107
Fax: (262) 780-0442
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 37946 | Wisconsin |
Profile Details
| NPI number | 1215958178 |
|---|---|
| LBN Legal business name | Axtell, Roger |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 23rd, 2006 |
| Last updated | Nov 18th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215958178 | NPPES |
| Wisconsin | MEDICAID | 33330500 |
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