Provider Demographics
NPI:1568758845
Name:MOBILE PHYSICIANS ASSOCIATION PC
Entity Type:Organization
Organization Name:MOBILE PHYSICIANS ASSOCIATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEKUNLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSHIYOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:248-562-7616
Mailing Address - Street 1:PO BOX 251062
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-1062
Mailing Address - Country:US
Mailing Address - Phone:248-562-7616
Mailing Address - Fax:248-562-7345
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE D-414
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-562-7616
Practice Address - Fax:248-562-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAO060924208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty