Provider Demographics
NPI:1205001716
Name:OAKLAND PHYSICAL MEDICINE AND REHAB
Entity Type:Organization
Organization Name:OAKLAND PHYSICAL MEDICINE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-651-4954
Mailing Address - Street 1:1050 W UNIVERSITY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1877
Mailing Address - Country:US
Mailing Address - Phone:248-651-4954
Mailing Address - Fax:248-650-1994
Practice Address - Street 1:1050 W UNIVERSITY DR STE 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1877
Practice Address - Country:US
Practice Address - Phone:248-651-4954
Practice Address - Fax:248-650-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6331240001Medicare NSC
MII48835Medicare UPIN
MI0P26960Medicare PIN