Healthcare Provider Details

I. General information

NPI: 1942393475
Provider Name (Legal Business Name): NORTH OAKLAND ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 NORTH OAKLAND BLVD
WATERFORD MI
48327-1547
US

IV. Provider business mailing address

461 WEST HURON ST SUITE 206
PONTIAC MI
48341-0000
US

V. Phone/Fax

Practice location:
  • Phone: 248-666-5552
  • Fax: 248-666-5549
Mailing address:
  • Phone: 248-857-7583
  • Fax: 248-857-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number636823
License Number StateMI

VIII. Authorized Official

Name: MICHAEL L DERUBEIS
Title or Position: CFO
Credential:
Phone: 248-857-7583