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General NPI Number Information
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NPI Number | 1942393475
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Entity Type | Organization
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Legal Business Name | NORTH OAKLAND ASC LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 1305 NORTH OAKLAND BLVD
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City | WATERFORD
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State | MI
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Zip | 48327-1547
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Country | US
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Telephone | 248-666-5552
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Fax | 248-666-5549
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Provider Business Mailing Address
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Address Line | 461 WEST HURON ST SUITE 206
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City | PONTIAC
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State | MI
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Zip | 48341-0000
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Country | US
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Telephone | 248-857-7583
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Fax | 248-857-7588
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL L DERUBEIS
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Credential |
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Telephone | 248-857-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 636823
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License Number State | MI
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