Healthcare Provider Details

I. General information

NPI: 1598743577
Provider Name (Legal Business Name): ONCOLOGY ALLIANCE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N MAYFAIR RD STE 200
WAUWATOSA WI
53226-3436
US

IV. Provider business mailing address

1055 N MAYFAIR RD SUITE 200
WAUWATOSA WI
53226-3436
US

V. Phone/Fax

Practice location:
  • Phone: 414-906-4467
  • Fax:
Mailing address:
  • Phone: 414-906-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKE KOROSCIK
Title or Position: COO
Credential:
Phone: 414-906-4400