Healthcare Provider Details

I. General information

NPI: 1457503781
Provider Name (Legal Business Name): OAKWOOD HEALHCARE GROUP 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 FORT ST SUITE 100
TRENTON MI
48183-4632
US

IV. Provider business mailing address

29601 BEAUMONT BLVD COMPLIANCE
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-362-1200
  • Fax:
Mailing address:
  • Phone: 947-522-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE ANN ODOM
Title or Position: PRESIDENT SHARED SERVICES
Credential:
Phone: 947-522-3326