Provider Demographics
NPI:1285470724
Name:BIRCHWOOD FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:BIRCHWOOD FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARJORIE
Authorized Official - Last Name:DALL-WINTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-202-6782
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BIRCHWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54817-0002
Mailing Address - Country:US
Mailing Address - Phone:715-202-6782
Mailing Address - Fax:
Practice Address - Street 1:101 WEST LOOMIS STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BIRCHWOOD
Practice Address - State:WI
Practice Address - Zip Code:54817
Practice Address - Country:US
Practice Address - Phone:715-202-6782
Practice Address - Fax:715-800-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty