Healthcare Provider Details

I. General information

NPI: 1013021583
Provider Name (Legal Business Name): OAK CREEK OB GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE SUITE 300
CENTERVILLE OH
45459
US

IV. Provider business mailing address

6438 WILMINGTON PIKE SUITE 300
CENTERVILLE OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-4850
  • Fax: 937-848-4858
Mailing address:
  • Phone: 937-848-4850
  • Fax: 937-848-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MICHAEL MCCULLOUGH JR.
Title or Position: SENIOR PHYSICIAN
Credential: MD
Phone: 937-848-4850