Provider Demographics
NPI:1598994311
Name:ST. JOHN OAKLAND
Entity Type:Organization
Organization Name:ST. JOHN OAKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-421-7495
Mailing Address - Street 1:27321 DEQUINDRE RD
Mailing Address - Street 2:19
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3474
Mailing Address - Country:US
Mailing Address - Phone:602-421-7495
Mailing Address - Fax:
Practice Address - Street 1:27321 DEQUINDRE RD
Practice Address - Street 2:19
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3474
Practice Address - Country:US
Practice Address - Phone:602-421-7495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018040282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital