Healthcare Provider Details

I. General information

NPI: 1124159231
Provider Name (Legal Business Name): NORTH OAKLAND DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N ROCHESTER RD SUITE 212
ROCHESTER HILLS MI
48306-4362
US

IV. Provider business mailing address

6700 N ROCHESTER RD SUITE 212
ROCHESTER HILLS MI
48306-4362
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-1510
  • Fax: 248-650-1526
Mailing address:
  • Phone: 248-650-1510
  • Fax: 248-650-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301049372
License Number StateMI

VIII. Authorized Official

Name: DR. EVA L YOUSHOCK
Title or Position: PRESIDENT
Credential: MD
Phone: 248-650-1510