1386178457 NPI number — HESHAM GAYAR, MD, PC

Table of content: (NPI 1386178457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386178457 NPI number — HESHAM GAYAR, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HESHAM GAYAR, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RADIATION ONCOLOGY CONSULTANTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386178457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 BEECHER RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-342-3813
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 SOUTH DR
Provider Second Line Business Practice Location Address:
MOREY CANCER CENTER RADIATION DEPT
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-772-6811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KNOPP
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
810-342-3813

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301056934 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)