Provider Demographics
NPI:1689860132
Name:ONCOLOGY ALLIANCE, S.C.
Entity Type:Organization
Organization Name:ONCOLOGY ALLIANCE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROSCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-906-4467
Mailing Address - Street 1:4655 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1004
Mailing Address - Country:US
Mailing Address - Phone:414-906-4467
Mailing Address - Fax:414-906-4437
Practice Address - Street 1:1055 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3436
Practice Address - Country:US
Practice Address - Phone:414-906-4467
Practice Address - Fax:414-906-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty