Healthcare Provider Details

I. General information

NPI: 1043320245
Provider Name (Legal Business Name): OAKLEAF PEDIATRIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 OAK RIDGE DR
EAU CLAIRE WI
54701-6133
US

IV. Provider business mailing address

1110 OAK RIDGE DR
EAU CLAIRE WI
54701-6133
US

V. Phone/Fax

Practice location:
  • Phone: 715-830-0732
  • Fax: 715-830-5487
Mailing address:
  • Phone: 715-830-0732
  • Fax: 715-830-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number35856
License Number StateWI

VIII. Authorized Official

Name: KARLA MARIE SCHLIMGEN
Title or Position: CO-OWNER
Credential: MD
Phone: 715-830-0732