Healthcare Provider Details

I. General information

NPI: 1285470724
Provider Name (Legal Business Name): BIRCHWOOD FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST LOOMIS STREET SUITE A
BIRCHWOOD WI
54817
US

IV. Provider business mailing address

PO BOX 2
BIRCHWOOD WI
54817-0002
US

V. Phone/Fax

Practice location:
  • Phone: 715-202-6782
  • Fax: 715-800-1982
Mailing address:
  • Phone: 715-202-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN MARJORIE DALL-WINTHER
Title or Position: OWNER/CEO
Credential: MD
Phone: 715-202-6782