Provider Demographics
NPI:1942187760
Name:KING, OLIVER D II
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:D
Last Name:KING
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-1373
Mailing Address - Country:US
Mailing Address - Phone:517-377-7728
Mailing Address - Fax:
Practice Address - Street 1:15762 ASHTON RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1304
Practice Address - Country:US
Practice Address - Phone:313-747-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications