MEDICARE: OAKWOOD AMBULATORY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	207Q00000X	Family Medicine Physician
3	2084P0800X	Psychiatry Physician
4	208600000X	Surgery Physician
5	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1538222062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKWOOD AMBULATORY, LLC

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 3RD ST
Second Line	:	SUITE 300
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2605
Country	:	US
Telephone Number	:	734-697-9055
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR SHARED SERVICES
Name	:	LESLEY WILLBRANDT
Credential	:
Telephone Number	:	947-522-1911

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/21/2019

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Directions to “OAKWOOD AMBULATORY, LLC ” Practice Location

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