Healthcare Provider Details

I. General information

NPI: 1932211141
Provider Name (Legal Business Name): OAK CREEK MEDICAL & PCCUPATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 S HOWELL AVE
OAK CREEK WI
53154-2112
US

IV. Provider business mailing address

N87W16462 JACOBSON DR
MENOMONEE FALLS WI
53051-2833
US

V. Phone/Fax

Practice location:
  • Phone: 414-766-0277
  • Fax:
Mailing address:
  • Phone: 262-255-1040
  • Fax: 262-255-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE MAHLER
Title or Position: PRESIDENT
Credential:
Phone: 414-766-0277