Provider Demographics
NPI:1326073701
Name:OAKLAND MEDICAL GROUP PC
Entity Type:Organization
Organization Name:OAKLAND MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-538-3099
Mailing Address - Street 1:11885 E 12 MILE RD
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3474
Mailing Address - Country:US
Mailing Address - Phone:586-757-5557
Mailing Address - Fax:586-757-2427
Practice Address - Street 1:11885 E 12 MILE RD
Practice Address - Street 2:SUITE 202B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3474
Practice Address - Country:US
Practice Address - Phone:586-757-5557
Practice Address - Fax:586-757-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherFEDERAL TAX ID
MI=========OtherFEDERAL TAX ID