Basic Information
| Provider Information | |||||||||
| NPI: | 1790708378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATEGRANO | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 S 70TH ST | ||||||||
| Address2: | SUITE N500 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144554780 | ||||||||
| FaxNumber: | 4144752936 | ||||||||
| Practice Location | |||||||||
| Address1: | 1834 WALDEN OFFICE SQ | ||||||||
| Address2: | #125 OAMRI OF SCHAUMBURG LLC | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473972300 | ||||||||
| FaxNumber: | 8473976140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1376728105 | 01 | IL | NPI NEW CORP | OTHER |