Healthcare Provider Details

I. General information

NPI: 1225042963
Provider Name (Legal Business Name): OAKWOOD HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

26901 BEAUMONT BLVD. COMPLIANCE
SOUTHFIELD MI
48033-4716
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax: 734-467-4017
Mailing address:
  • Phone: 947-522-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number820010
License Number StateMI

VIII. Authorized Official

Name: LESLEY WILLBRANDT
Title or Position: DIRECTOR SHARED SERVICES
Credential:
Phone: 947-522-1911