Provider Demographics
NPI:1144250366
Name:OAKTREE SURGERY, INC.
Entity type:Organization
Organization Name:OAKTREE SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-841-2303
Mailing Address - Street 1:3438 GRANITE CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1160
Mailing Address - Country:US
Mailing Address - Phone:419-841-2303
Mailing Address - Fax:419-842-1161
Practice Address - Street 1:3438 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1160
Practice Address - Country:US
Practice Address - Phone:419-841-2303
Practice Address - Fax:419-842-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3030208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty