Provider Demographics
NPI:1780859710
Name:OAK PARK MEDICAL CENTER PC
Entity Type:Organization
Organization Name:OAK PARK MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-968-2003
Mailing Address - Street 1:15300 W 9 MILE RD
Mailing Address - Street 2:STE.1
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2584
Mailing Address - Country:US
Mailing Address - Phone:248-968-2003
Mailing Address - Fax:248-968-2276
Practice Address - Street 1:15300 W 9 MILE RD
Practice Address - Street 2:STE.1
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2584
Practice Address - Country:US
Practice Address - Phone:248-968-2003
Practice Address - Fax:248-968-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052904261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N30370Medicare PIN