Provider Demographics
NPI:1245569607
Name:OAKLAND PRIMARY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:OAKLAND PRIMARY HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-322-6747
Mailing Address - Street 1:46 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2155
Mailing Address - Country:US
Mailing Address - Phone:248-322-6747
Mailing Address - Fax:
Practice Address - Street 1:2989 VAN ZANDT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3360
Practice Address - Country:US
Practice Address - Phone:248-674-4876
Practice Address - Fax:248-674-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health