Provider Demographics
NPI:1124282686
Name:ST JOSEPH MERCY OF OAKLAND
Entity type:Organization
Organization Name:ST JOSEPH MERCY OF OAKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON INTERN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-289-1284
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-758-3234
Mailing Address - Fax:
Practice Address - Street 1:3290 S ADAMS RD
Practice Address - Street 2:APT 302
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3395
Practice Address - Country:US
Practice Address - Phone:312-520-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092346282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital