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General NPI Number Information
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NPI Number | 1669910345
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Entity Type | Organization
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Legal Business Name | OAK MEDICAL SC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 2428 N GRANDVIEW BLVD
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City | WAUKESHA
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State | WI
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Zip | 53188-6906
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Country | US
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Telephone | 262-875-5070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 474
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City | HARTLAND
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State | WI
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Zip | 53029-0474
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MAHTAB SIDHU
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Credential | M.D.
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Telephone | 262-875-5070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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