# CARBON HEALTH MEDICAL GROUP OF WISCONSIN SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912616194
- **Authorized official:** MARLEY PAGE (DIRECTOR)
- **Authorized official phone:** (417) 861-9739

## Contact information

- **Practice address:** 11415 W BURLEIGH ST STE 103, WAUWATOSA, WI 53222-3217
- **Practice address phone:** (844) 234-7741
- **Mailing address:** 2100 FRANKLIN ST STE 355, OAKLAND, CA 94612-3140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/16/2022
- **Last updated:** 06/24/2025