Provider Demographics
NPI:1528155264
Name:OAKLAND PEDIATRICS, PLC
Entity type:Organization
Organization Name:OAKLAND PEDIATRICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIZK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-699-2273
Mailing Address - Street 1:100 N POND DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3079
Mailing Address - Country:US
Mailing Address - Phone:248-669-2273
Mailing Address - Fax:
Practice Address - Street 1:100 N POND DR
Practice Address - Street 2:SUITE E
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3079
Practice Address - Country:US
Practice Address - Phone:248-669-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRR052769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350F339890OtherBCBS OF MICHIGAN
MIF70284Medicare UPIN
MIF70284Medicare UPIN
MIC6222OtherMCARE
MI106348OtherCARE CHOICES