Organization
CREEKSIDE FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL J HEIKS M.D. (SOLE MEMBER)
(330) 466-4431
Entity
Organization
Contact information
Practice address
3608 N BRACKEN DR, APPLETON, WI 54911-8504
(330) 466-4431
Mailing address
3608 N BRACKEN DR, APPLETON, WI 54911-8504
(330) 466-4431
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
35097870
OH
Other
Enumeration date
08/30/2012
Last updated
10/21/2014
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