MEDICARE: OAKLAND PEDIATRICS, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	RR052769	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350F339890	OTHER	MI	BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1528155264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND PEDIATRICS, PLC

Provider Business Mailing Address
First Line	:	100 N POND DR
Second Line	:	SUITE E
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3079
Country	:	US
Telephone Number	:	248-669-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N POND DR
Second Line	:	SUITE E
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3079
Country	:	US
Telephone Number	:	248-669-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REGINA E RIZK
Credential	:	MD
Telephone Number	:	248-699-2273

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	04/25/2014

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