Provider Demographics
NPI:1457498081
Name:OAKLAND PHYSIATRY P.C.
Entity Type:Organization
Organization Name:OAKLAND PHYSIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSIST. OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORONIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-3949
Mailing Address - Street 1:44555 WOODWARD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5035
Mailing Address - Country:US
Mailing Address - Phone:248-858-3949
Mailing Address - Fax:248-858-3929
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-3949
Practice Address - Fax:248-858-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P42800Medicare PIN