Provider Demographics
NPI:1053483461
Name:OAKLAND ARTHRITIS CENTER P C
Entity Type:Organization
Organization Name:OAKLAND ARTHRITIS CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-646-1965
Mailing Address - Street 1:32270 TELEGRAPH RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-646-1965
Mailing Address - Fax:248-646-7293
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-646-1965
Practice Address - Fax:248-646-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RR05500X207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID NUMBER
MIC30435Medicare PIN