Provider Demographics
NPI:1013021583
Name:OAK CREEK OB GYN INC
Entity Type:Organization
Organization Name:OAK CREEK OB GYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:937-848-4850
Mailing Address - Street 1:6438 WILMINGTON PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-848-4850
Mailing Address - Fax:937-848-4858
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-848-4850
Practice Address - Fax:937-848-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9294871Medicare PIN