Basic Information
| Provider Information | |||||||||
| NPI: | 1508167107 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH OAKLAND ASC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 461 W HURON ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483411601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488577583 | ||||||||
| FaxNumber: | 2488577588 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 N OAKLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483271547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486665552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 11/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | DERUBEIS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2488577583 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OAKLAND PHYSICIANS MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.