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Organization
NEXT GENERATION FAMILY MEDICAL CLINIC, LLC
Active
Organization
NEXT GENERATION FAMILY MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELE BUCHOLTZ D.O.,PH.D (PRESIDENT)
(918) 201-4502
Entity
Organization
Contact information
Practice address
1102 W CHEROKEE ST STE A, WAGONER, OK 74467-4600
(918) 201-4502
(918) 201-4503
Mailing address
1102 W CHEROKEE ST STE A, WAGONER, OK 74467-4600
(918) 201-4502
(918) 201-4503
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4383
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275754780
—
OK
Enumeration date
08/06/2015
Last updated
02/22/2016
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