Provider Demographics
NPI:1194011643
Name:OAKLAND DIGESTIVE DISEASE,PLLC
Entity Type:Organization
Organization Name:OAKLAND DIGESTIVE DISEASE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-858-3878
Mailing Address - Street 1:4455 WOODWARD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5022
Mailing Address - Country:US
Mailing Address - Phone:248-858-3878
Mailing Address - Fax:248-209-6777
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:STE 304
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5035
Practice Address - Country:US
Practice Address - Phone:248-858-3878
Practice Address - Fax:248-209-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091849174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty