Healthcare Provider Details

I. General information

NPI: 1144246653
Provider Name (Legal Business Name): OAKWOOD GROUP X LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 109
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 109
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-5880
  • Fax: 313-593-8837
Mailing address:
  • Phone: 313-593-5880
  • Fax: 313-593-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberDM007496
License Number StateMI

VIII. Authorized Official

Name: DONNA THIEMANN
Title or Position: MANAGER
Credential:
Phone: 313-593-5880