Healthcare Provider Details

I. General information

NPI: 1104285139
Provider Name (Legal Business Name): OAKLAND PRIMARY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N SAGINAW ST
PONTIAC MI
48342-2155
US

IV. Provider business mailing address

46 N SAGINAW ST
PONTIAC MI
48342-2155
US

V. Phone/Fax

Practice location:
  • Phone: 248-322-6747
  • Fax: 248-322-5787
Mailing address:
  • Phone: 248-322-6747
  • Fax: 248-322-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON BERRY
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 248-322-6747