MEDICARE: ALPHA MEDICAL CLINIC SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	30809	WI

General Provider Information

NPI Number	:	1134228133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL CLINIC SC

Provider Business Mailing Address
First Line	:	6001 W CENTER ST
Second Line	:	SUITE 102
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2154
Country	:	US
Telephone Number	:	414-444-4484
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 W CENTER ST
Second Line	:	SUITE 102
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2154
Country	:	US
Telephone Number	:	414-444-4484
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLUSOJI OYESANYA
Credential	:	MD
Telephone Number	:	414-444-4484

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/05/2007

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Directions to “ALPHA MEDICAL CLINIC SC ” Practice Location

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