Provider Demographics
NPI:1982767422
Name:OAKWOOD AMBULATORY, LLC
Entity Type:Organization
Organization Name:OAKWOOD AMBULATORY, LLC
Other - Org Name:BELLEVILLE OB GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BEAUMONT SHARED SVCS
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-1911
Mailing Address - Street 1:26901 BEAUMONT BOULEVARD
Mailing Address - Street 2:STE. 3D
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1857
Mailing Address - Fax:
Practice Address - Street 1:355 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2645
Practice Address - Country:US
Practice Address - Phone:734-699-5341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N84060Medicare ID - Type Unspecified