Healthcare Provider Details

I. General information

NPI: 1215128293
Provider Name (Legal Business Name): OAKLAND COLON & RECTAL ASSOC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CROOKS RD
ROYAL OAK MI
48067
US

IV. Provider business mailing address

1121 CROOKS RD
ROYAL OAK MI
48067
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-8554
  • Fax: 248-541-1791
Mailing address:
  • Phone: 248-541-8554
  • Fax: 248-541-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: HARRY WASVARY
Title or Position: OWNER
Credential: MD
Phone: 248-541-8554