Provider Demographics
NPI:1508167107
Name:NORTH OAKLAND ASC, LLC
Entity Type:Organization
Organization Name:NORTH OAKLAND ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERUBEIS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:248-857-7583
Mailing Address - Street 1:461 W HURON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-857-7583
Mailing Address - Fax:248-857-7588
Practice Address - Street 1:1305 N OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1547
Practice Address - Country:US
Practice Address - Phone:248-666-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND PHYSICIANS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty