Healthcare Provider Details

I. General information

NPI: 1528155264
Provider Name (Legal Business Name): OAKLAND PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N POND DR SUITE E
WALLED LAKE MI
48390-3079
US

IV. Provider business mailing address

100 N POND DR SUITE E
WALLED LAKE MI
48390-3079
US

V. Phone/Fax

Practice location:
  • Phone: 248-669-2273
  • Fax:
Mailing address:
  • Phone: 248-669-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRR052769
License Number StateMI

VIII. Authorized Official

Name: DR. REGINA E RIZK
Title or Position: PRESIDENT
Credential: MD
Phone: 248-699-2273