MEDICARE: ST. JOHN OAKLAND

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	282N00000X	General Acute Care Hospital	5101018040	MI

General Provider Information

NPI Number	:	1598994311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHN OAKLAND

Provider Business Mailing Address
First Line	:	27321 DEQUINDRE RD
Second Line	:	19
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3474
Country	:	US
Telephone Number	:	602-421-7495
Fax Number	:

Provider Business Practice Location Address
First Line	:	27321 DEQUINDRE RD
Second Line	:	19
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3474
Country	:	US
Telephone Number	:	602-421-7495
Fax Number	:

Authorized Official
Title or Position	:	EMERGENCY MEDICINE
Name	:	DR. KEVIN MICHAEL MCKEOWN
Credential	:	D.O
Telephone Number	:	602-421-7495

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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Directions to “ST. JOHN OAKLAND ” Practice Location

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