MEDICARE: OBSTETRICS GYNECOLOGY CLINIC OF EAU CLAIRE, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician		WI
2	207VX0000X	Obstetrics Physician		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619037918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBSTETRICS GYNECOLOGY CLINIC OF EAU CLAIRE, S.C.

Provider Business Mailing Address
First Line	:	1110 OAK RIDGE DR
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6133
Country	:	US
Telephone Number	:	715-836-9020
Fax Number	:	715-834-9833

Provider Business Practice Location Address
First Line	:	1110 OAK RIDGE DR
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6133
Country	:	US
Telephone Number	:	715-836-9020
Fax Number	:	715-834-9833

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRFANE M. KHATIB
Credential	:	M.D.
Telephone Number	:	715-836-9020

Provider Enumeration Date	:	12/10/2006
Last Update Date	:	09/11/2025

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