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NPI Code Detail

MEDICARE: OAKLAND DIGESTIVE HEALTH, LLC

MEDICARE: OAKLAND DIGESTIVE HEALTH, LLC
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
1174400000XSpecialist4301078345MI

General Provider Information

NPI Number : 1720200942
Entity Type Code : Organization
Provider Name (Legal Business Name) : OAKLAND DIGESTIVE HEALTH, LLC
Provider Business Mailing Address
First Line : 2700 S ROCHESTER RD
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4547
Country : US
Telephone Number : 248-844-2700
Fax Number : 248-852-0806
Provider Business Practice Location Address
First Line : 2700 S ROCHESTER RD
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4547
Country : US
Telephone Number : 248-844-2700
Fax Number : 248-852-0806
Authorized Official
Title or Position : PRESIDENT
Name : DR. KAMBIZ BRAL
Credential : MD
Telephone Number : 248-844-2700
Provider Enumeration Date : 05/03/2007
Last Update Date : 08/22/2020

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