Healthcare Provider Details

I. General information

NPI: 1104121615
Provider Name (Legal Business Name): OAK TREE PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 09/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E GRAND RIVER AVE
BRIGHTON MI
48116-1515
US

IV. Provider business mailing address

401 E GRAND RIVER AVE
BRIGHTON MI
48116-1515
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-7334
  • Fax: 810-225-3262
Mailing address:
  • Phone: 810-225-7334
  • Fax: 810-225-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301074426
License Number StateMI

VIII. Authorized Official

Name: DR. DEBORAH A MCEWEN
Title or Position: PRESIDENT
Credential: MD
Phone: 810-225-7334