MEDICARE: OAKLAND PSYCHIATRIC ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician		MI
2	2084P0800X	Psychiatry Physician	NJ042763	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260F377910	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1184799736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND PSYCHIATRIC ASSOCIATES PC

Provider Business Mailing Address
First Line	:	43700 WOODWARD AVE STE 301
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5062
Country	:	US
Telephone Number	:	248-335-4010
Fax Number	:	248-858-3874

Provider Business Practice Location Address
First Line	:	43700 WOODWARD AVE STE 301
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5062
Country	:	US
Telephone Number	:	248-335-4010
Fax Number	:	248-977-3860

Authorized Official
Title or Position	:	CONTROLLER
Name	:	LINDA MONDROW
Credential	:
Telephone Number	:	248-682-0741

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/21/2018

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