Provider Demographics
NPI:1184836983
Name:OAKLAND PHYSICANS MEDICAL CENTER
Entity Type:Organization
Organization Name:OAKLAND PHYSICANS MEDICAL CENTER
Other - Org Name:DOCTORS' HOSPITAL OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-857-7319
Mailing Address - Street 1:461 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-857-6771
Mailing Address - Fax:248-857-6825
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-857-6771
Practice Address - Fax:248-857-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010089743336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2324729OtherNCPDP PROVIDER IDENTIFICATION NUMBER