Provider Demographics
NPI:1942088414
Name:ROCHESTER OAKLAND VENTURES INC
Entity Type:Organization
Organization Name:ROCHESTER OAKLAND VENTURES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:KOCENDA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:888-229-1777
Mailing Address - Street 1:2632 S ROCHESTER RD UNIT 70501
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-7923
Mailing Address - Country:US
Mailing Address - Phone:888-229-1777
Mailing Address - Fax:888-228-3870
Practice Address - Street 1:1245 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1346
Practice Address - Country:US
Practice Address - Phone:888-229-1777
Practice Address - Fax:888-228-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty