Provider Demographics
NPI:1124159231
Name:NORTH OAKLAND DERMATOLOGY PC
Entity type:Organization
Organization Name:NORTH OAKLAND DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUSHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-650-1510
Mailing Address - Street 1:6700 N ROCHESTER RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4362
Mailing Address - Country:US
Mailing Address - Phone:248-650-1510
Mailing Address - Fax:248-650-1526
Practice Address - Street 1:6700 N ROCHESTER RD
Practice Address - Street 2:SUITE 212
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4362
Practice Address - Country:US
Practice Address - Phone:248-650-1510
Practice Address - Fax:248-650-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE77738Medicare UPIN
MI0631754Medicare PIN