Provider Demographics
NPI:1417058314
Name:OAK CREEK OBGYN
Entity Type:Organization
Organization Name:OAK CREEK OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICIAN OF PRACTICE
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:45459-7010
Mailing Address - Country:US
Mailing Address - Phone:937-848-4850
Mailing Address - Fax:937-848-4858
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-431-0200
Practice Address - Fax:937-431-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOA9294871Medicare PIN