Healthcare Provider Details

I. General information

NPI: 1285069799
Provider Name (Legal Business Name): OAK MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 N GRANDVIEW BLVD SUITE 102
WAUKESHA WI
53188-6906
US

IV. Provider business mailing address

PO BOX 474
HARTLAND WI
53029-0474
US

V. Phone/Fax

Practice location:
  • Phone: 319-601-9279
  • Fax:
Mailing address:
  • Phone: 877-307-3226
  • Fax: 866-384-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARFRAZ SIDHU
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 414-731-9731