Provider Demographics
NPI:1124053509
Name:OAKLAND MEDICAL GROUP PC
Entity type:Organization
Organization Name:OAKLAND MEDICAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-538-3099
Mailing Address - Street 1:1385 E 12 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2602
Mailing Address - Country:US
Mailing Address - Phone:248-399-6090
Mailing Address - Fax:248-399-5282
Practice Address - Street 1:1385 E 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2602
Practice Address - Country:US
Practice Address - Phone:248-399-6090
Practice Address - Fax:248-399-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M81740Medicare PIN