Provider Demographics
NPI:1548256126
Name:OAKLAND COUNTY UROLOGISTS PC
Entity type:Organization
Organization Name:OAKLAND COUNTY UROLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-674-8530
Mailing Address - Street 1:3145 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3145 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1602
Practice Address - Country:US
Practice Address - Phone:248-674-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKL007576208800000X
MIWM007547208800000X
MILC001596208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1764655Medicaid
MI1506795Medicaid
MI3484033Medicaid
MIG75310Medicare UPIN
MIOF37245Medicare ID - Type UnspecifiedLIM
MIOF37245Medicare ID - Type UnspecifiedMCDEVITT
MI3484033Medicaid
MIE31580Medicare UPIN
MI1506795Medicaid