Provider Demographics
NPI:1215253216
Name:NORTH OAKLAND GASTROENTEROLOGY CLINIC PC
Entity type:Organization
Organization Name:NORTH OAKLAND GASTROENTEROLOGY CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-329-1884
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5820
Mailing Address - Country:US
Mailing Address - Phone:248-844-2700
Mailing Address - Fax:248-852-0806
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-844-2700
Practice Address - Fax:248-852-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory