Basic Information
Provider Information
NPI: 1801141759
EntityType: 2
ReplacementNPI:  
OrganizationName: OAKWOOD HOSPITAL AND MEDICAL CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26901 BEAUMONT BLVD.
Address2: COMPLAINCE
City: SOUTHFIELD
State: MI
PostalCode: 480334716
CountryCode: US
TelephoneNumber: 9475221963
FaxNumber:  
Practice Location
Address1: 18101 OAKWOOD BLVD
Address2:  
City: DEARBORN
State: MI
PostalCode: 481244089
CountryCode: US
TelephoneNumber: 3135937000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/17/2012
LastUpdateDate: 10/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ODOM
AuthorizedOfficialFirstName: LEE
AuthorizedOfficialMiddleName: ANN
AuthorizedOfficialTitleorPosition: PRESIDENT SHARED SERVICES
AuthorizedOfficialTelephone: 9475223326
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X4301101372MIY HospitalsGeneral Acute Care Hospital 

No ID Information.


Home