Healthcare Provider Details

I. General information

NPI: 1073509659
Provider Name (Legal Business Name): OAKLAND NEUROSURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 W 13 MILE RD
ROYAL OAK MI
48073-6502
US

IV. Provider business mailing address

4203 W 13 MILE RD
ROYAL OAK MI
48073-6502
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-2025
  • Fax: 248-288-6733
Mailing address:
  • Phone: 248-288-2025
  • Fax: 248-288-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICKY E OLSON
Title or Position: PRESIDENT
Credential: MD
Phone: 248-288-2025