Provider Demographics
NPI:1962765529
Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Entity type:Organization
Organization Name:OAKLAND INTEGRATED HEALTHCARE NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-724-7438
Mailing Address - Street 1:P.O. BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343
Mailing Address - Country:US
Mailing Address - Phone:248-724-7600
Mailing Address - Fax:248-636-4043
Practice Address - Street 1:114 ORCHARD LAKE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2244
Practice Address - Country:US
Practice Address - Phone:248-724-7605
Practice Address - Fax:248-636-4043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND INTEGRATED HEALTHCARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231019Medicare Oscar/Certification