MEDICARE: OAKLAND INTEGRATED HEALTHCARE NETWORK

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1205363207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND INTEGRATED HEALTHCARE NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 430150
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48343-0150
Country	:	US
Telephone Number	:	248-724-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 N PERRY ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-3135
Country	:	US
Telephone Number	:	248-857-7432
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEBRA BRINSON
Credential	:
Telephone Number	:	517-281-7149

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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