1093151433 NPI number — NORTH OAKLAND NEUROSURGERY, PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093151433 NPI number — NORTH OAKLAND NEUROSURGERY, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH OAKLAND NEUROSURGERY, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093151433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5220 HIGHLAND RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48327-1975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-383-1030
Provider Business Mailing Address Fax Number:
248-383-1031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5220 HIGHLAND RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48327-1975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-383-1030
Provider Business Practice Location Address Fax Number:
248-383-1031
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
O'HARA
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
EDWIN
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
248-383-1030

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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