Healthcare Provider Details

I. General information

NPI: 1174765945
Provider Name (Legal Business Name): MCLAREN OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8172 RELIABLE PKWY
CHICAGO IL
60686-0001
US

IV. Provider business mailing address

8172 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 517-908-0847
  • Fax: 517-381-8011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BARTON BUXTON
Title or Position: CEO
Credential:
Phone: 248-338-5380