Provider Demographics
NPI:1881707172
Name:OH, HEUNG KIL (MD)
Entity type:Individual
Prefix:DR
First Name:HEUNG
Middle Name:KIL
Last Name:OH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22101 MOROSS RD
Mailing Address - Street 2:PB2 SUITE 480
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-3048
Mailing Address - Fax:313-343-7349
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:PB2 SUITE 480 SJHMC DEPARTMENT OF TRANSPLANT SURGERY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-3048
Practice Address - Fax:313-343-7349
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034672208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2625932Medicaid
MI2625932Medicaid
MI230165Medicare ID - Type Unspecified