Provider Demographics
NPI:1346283595
Name:BEAVER DAM WOMEN'S HEALTH, LTD.
Entity Type:Organization
Organization Name:BEAVER DAM WOMEN'S HEALTH, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:V
Authorized Official - Last Name:OSTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-885-6090
Mailing Address - Street 1:705 S. UNIVERSITY AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916
Mailing Address - Country:US
Mailing Address - Phone:920-885-6090
Mailing Address - Fax:920-885-6092
Practice Address - Street 1:705 S. UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916
Practice Address - Country:US
Practice Address - Phone:920-885-6090
Practice Address - Fax:920-885-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36431207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32893800Medicaid