Provider Demographics
NPI:1346241775
Name:OAKLAND SURGI-CENTER INC
Entity Type:Organization
Organization Name:OAKLAND SURGI-CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDRANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBHAMPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-9411
Mailing Address - Street 1:2820 CROOKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3607
Mailing Address - Country:US
Mailing Address - Phone:248-852-7484
Mailing Address - Fax:248-852-4279
Practice Address - Street 1:2820 CROOKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3607
Practice Address - Country:US
Practice Address - Phone:248-852-7484
Practice Address - Fax:248-852-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI636828261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01297 10012740001OtherWELLNESS PLAN
5 P80979OtherBLUECARE NETWORK
978 P0630166OtherMCARE PO BOX 13-800
01757 OP630166OtherMCARE 6500 JOHN C LODGE
X17020Medicare UPIN
0F37300Medicare ID - Type Unspecified
MI0F37300Medicare PIN