Provider Demographics
NPI:1043245434
Name:OAKLAND MEDICAL GROUP PC
Entity Type:Organization
Organization Name:OAKLAND MEDICAL GROUP PC
Other - Org Name:HAZEL OARK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-538-3099
Mailing Address - Street 1:23411 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1404
Mailing Address - Country:US
Mailing Address - Phone:248-399-8331
Mailing Address - Fax:248-399-3912
Practice Address - Street 1:23411 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1404
Practice Address - Country:US
Practice Address - Phone:248-399-8331
Practice Address - Fax:248-399-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDA8060OtherMEDICARE ID TYPE UNSPECIFIED
MI700F310000OtherBLUE SHIELD GROUP
MI700F310000OtherBLUE SHIELD GROUP