Healthcare Provider Details

I. General information

NPI: 1962457051
Provider Name (Legal Business Name): OAKLAND ORTHOPAEDIC SURGEONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30575 WOODWARD AVE STE 100
ROYAL OAK MI
48073
US

IV. Provider business mailing address

30575 WOODWARD AVE STE 100
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-280-8550
  • Fax: 248-280-8571
Mailing address:
  • Phone: 248-280-8550
  • Fax: 248-280-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LANE R BROWN
Title or Position: MD
Credential: MD
Phone: 248-280-8550