Provider Demographics
NPI:1720207798
Name:OAKLAND MACOMB INTERNAL MEDICINE GROUP, PC
Entity Type:Organization
Organization Name:OAKLAND MACOMB INTERNAL MEDICINE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-829-1956
Mailing Address - Street 1:645 BARCLAY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5804
Mailing Address - Country:US
Mailing Address - Phone:248-829-1956
Mailing Address - Fax:248-289-1871
Practice Address - Street 1:645 BARCLAY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5804
Practice Address - Country:US
Practice Address - Phone:248-829-1956
Practice Address - Fax:248-289-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3225372Medicaid