Provider Demographics
NPI:1528149143
Name:WEST OAKLAND OBGYN PLLC
Entity type:Organization
Organization Name:WEST OAKLAND OBGYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:GNISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-848-1479
Mailing Address - Street 1:34505 W 12 MILE RD
Mailing Address - Street 2:SUITE # 195
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3258
Mailing Address - Country:US
Mailing Address - Phone:248-848-1479
Mailing Address - Fax:248-848-1578
Practice Address - Street 1:34505 W 12 MILE RD
Practice Address - Street 2:SUITE # 195
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3258
Practice Address - Country:US
Practice Address - Phone:248-848-1479
Practice Address - Fax:248-848-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM76020Medicare ID - Type Unspecified