Basic Information
| Provider Information | |||||||||
| NPI: | 1376629444 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OAKLAND MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25241 GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | REDFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482401404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135383099 | ||||||||
| FaxNumber: | 3135383282 | ||||||||
| Practice Location | |||||||||
| Address1: | 27301 DEQUINDRE RD | ||||||||
| Address2: | 102 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485448644 | ||||||||
| FaxNumber: | 2485448876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 08/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARGOLIS | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3135383099 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.