Healthcare Provider Details

I. General information

NPI: 1376728857
Provider Name (Legal Business Name): OAK NEUROVASCULAR P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24361 GREENFIELD RD SUITE 202
SOUTHFIELD MI
48075-3139
US

IV. Provider business mailing address

PO BOX 2300
FARMINGTON HILLS MI
48333-2300
US

V. Phone/Fax

Practice location:
  • Phone: 313-369-3379
  • Fax:
Mailing address:
  • Phone: 248-320-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: MR. TUSHAR TRIPATHI
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 313-369-3379