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General NPI Number Information
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NPI Number | 1598743577
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Entity Type | Organization
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Legal Business Name | ONCOLOGY ALLIANCE, S.C.
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1055 N MAYFAIR RD STE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-3436
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Country | US
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Telephone | 414-906-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 N MAYFAIR RD SUITE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-3436
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Country | US
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Telephone | 414-906-4467
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MIKE KOROSCIK
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Credential |
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Telephone | 414-906-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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