Organization · Type 2 NPI

Diaspora Radiology, SC

Diagnostic Radiology Physician · Weston, WI

NPI number 1861119612 Active

Practice location

2106 Schofield Ave Ste 7
Weston, WI 54476-2412

Call (847) 878-9109 Map

Mailing address

1914 Pine Dr
Mchenry, IL 60051-2620

Specialties and licenses

Taxonomy	Code	License
Diagnostic Radiology Physician Primary	2085R0202X	None listed

Diagnostic Radiology Physician: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Another provider at this address

Smart Scan Medical Imaging - Wausau, LLCRadiology Clinic/Center Weston, WI NPI 1821834789

NPI record

NPI: 1861119612
Entity type: Organization (Type 2)
Issued: Oct 24, 2022
Last updated: Oct 24, 2022
Status: Active
Subpart: Yes of Diaspora Radiology, SC

Other names

Smart Scan Medical Imaging Wausau · doing business as

Authorized official

Maria Corona
Senior Director, Operations
(847) 878-9109

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1861119612

Diaspora Radiology, SC's National Provider Identifier is 1861119612, issued on Oct 24, 2022. The primary taxonomy on file is Diagnostic Radiology Physician (2085R0202X), and the practice location is in Weston, WI. The record was last updated on Oct 24, 2022.