Basic Information
| Provider Information | |||||||||
| NPI: | 1174585582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIELD | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 N CALHOUN RD | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530055036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | 2627803396 | ||||||||
| Practice Location | |||||||||
| Address1: | 1905 N CALHOUN RD | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627548000 | ||||||||
| FaxNumber: | 2627803396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 48340 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1174585582 | 05 | WI | MEDICAID |