Provider Demographics
NPI:1104285139
Name:OAKLAND PRIMARY HEALTH SERVICES
Entity type:Organization
Organization Name:OAKLAND PRIMARY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:248-322-6747
Mailing Address - Street 1:46 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2155
Mailing Address - Country:US
Mailing Address - Phone:248-322-6747
Mailing Address - Fax:248-322-5787
Practice Address - Street 1:46 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2155
Practice Address - Country:US
Practice Address - Phone:248-322-6747
Practice Address - Fax:248-322-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty