Healthcare Provider Details

I. General information

NPI: 1104334630
Provider Name (Legal Business Name): OAKLAND ENT PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ORCHARD LAKE RD STE 314
WEST BLOOMFIELD MI
48322-3457
US

IV. Provider business mailing address

6900 ORCHARD LAKE RD STE 314
WEST BLOOMFIELD MI
48322-3457
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-7530
  • Fax: 248-855-5639
Mailing address:
  • Phone: 248-855-7530
  • Fax: 248-855-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY MELISSA MCBRIEN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 248-855-7530