Healthcare Provider Details

I. General information

NPI: 1700935285
Provider Name (Legal Business Name): OAKWOOD AMBULATORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N CANTON CENTER RD
CANTON MI
48187-1579
US

IV. Provider business mailing address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-454-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LESLEY WILLBRANDT
Title or Position: SR. DIRECTOR BEAUMONT SHARED SVCS
Credential:
Phone: 947-522-1911