Basic Information
| Provider Information | |||||||||
| NPI: | 1932211141 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAK CREEK MEDICAL & PCCUPATIONAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | N87W16462 JACOBSON DR | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622551040 | ||||||||
| FaxNumber: | 2622554090 | ||||||||
| Practice Location | |||||||||
| Address1: | 7625 S HOWELL AVE | ||||||||
| Address2: | |||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531542112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147660277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAHLER | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4147660277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 363AM0700X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.