1316116726 NPI number — HEMATOLOGY-ONCOLOGY ASSOC. EAST, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316116726 NPI number — HEMATOLOGY-ONCOLOGY ASSOC. EAST, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY-ONCOLOGY ASSOC. EAST, 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:
Provider Other Organization Name Type Code:
6
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:
1316116726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19229 MACK AVE
Provider Second Line Business Mailing Address:
SUITE 24
Provider Business Mailing Address City Name:
GROSSE POINTE WOODS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-2858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-884-5522
Provider Business Mailing Address Fax Number:
313-884-5521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11051 HALL RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48317-5735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-991-0700
Provider Business Practice Location Address Fax Number:
586-991-0701
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MAJOR
Authorized Official First Name:
MOLLI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGEMENT
Authorized Official Telephone Number:
313-884-1059

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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