Provider Demographics
NPI:1235388604
Name:OAKWOOD FAMILY MEDICAL CLINIC,S.C.
Entity Type:Organization
Organization Name:OAKWOOD FAMILY MEDICAL CLINIC,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-270-0777
Mailing Address - Street 1:1845 N FARWELL AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1715
Mailing Address - Country:US
Mailing Address - Phone:414-270-0777
Mailing Address - Fax:
Practice Address - Street 1:1845 N FARWELL AVE STE 207
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1715
Practice Address - Country:US
Practice Address - Phone:414-270-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36860261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21263100Medicaid
WI000001073Medicare PIN