Healthcare Provider Details

I. General information

NPI: 1134370752
Provider Name (Legal Business Name): OAKLAND PHYSICIANS MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 WEST HURON STREET
PONTIAC MI
48341
US

IV. Provider business mailing address

461 WEST HURON STREET
PONTIAC MI
48341
US

V. Phone/Fax

Practice location:
  • Phone: 248-857-7200
  • Fax: 248-857-6842
Mailing address:
  • Phone: 248-857-7200
  • Fax: 248-857-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY JODWAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 248-857-7200