Healthcare Provider Details

I. General information

NPI: 1942088414
Provider Name (Legal Business Name): ROCHESTER OAKLAND VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 N MAIN ST STE B
LAPEER MI
48446-1346
US

IV. Provider business mailing address

2632 S ROCHESTER RD UNIT 70501
ROCHESTER HILLS MI
48307-7923
US

V. Phone/Fax

Practice location:
  • Phone: 888-229-1777
  • Fax: 888-228-3870
Mailing address:
  • Phone: 888-229-1777
  • Fax: 888-228-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID WALTER KOCENDA
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 888-229-1777