Basic Information
| Provider Information | |||||||||
| NPI: | 1952874141 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAKLEAF CLINICS INC | ||||||||
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| OtherOrganizationName: | OAKLEAF CLINICS, AMY LUDWIKOWSKI, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 W HAMILTON AVE STE B | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155529784 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 431 E CLAIREMONT AVE STE C | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155145724 | ||||||||
| FaxNumber: | 7155145734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | LONGBELLA | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7158369242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OAKLEAF CLINICS INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.