Provider Demographics
NPI:1740231034
Name:OAKLEAF NEUROLOGY & SLEEP P C
Entity type:Organization
Organization Name:OAKLEAF NEUROLOGY & SLEEP P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-846-8840
Mailing Address - Street 1:5141 OAKMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3714
Mailing Address - Country:US
Mailing Address - Phone:313-846-8840
Mailing Address - Fax:313-846-8840
Practice Address - Street 1:5141 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3714
Practice Address - Country:US
Practice Address - Phone:313-846-8840
Practice Address - Fax:313-846-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N91850Medicare ID - Type UnspecifiedGROUP NUMBER