Provider Demographics
NPI:1275520777
Name:ROYAL OAK OB GYN PC
Entity Type:Organization
Organization Name:ROYAL OAK OB GYN PC
Other - Org Name:ANIS A MILAD MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5867-994-3500
Mailing Address - Street 1:43200 DEQUINDRE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1707
Mailing Address - Country:US
Mailing Address - Phone:586-799-4350
Mailing Address - Fax:586-799-4279
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:STE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:586-799-4350
Practice Address - Fax:586-799-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028599207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B44649OtherHAP
1606319301OtherBLUE CROSS
B44649Medicare UPIN
MIP01590001Medicare ID - Type Unspecified