1568548147 NPI number — MICHIGAN CANCER CENTER PC

Table of content: (NPI 1568548147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568548147 NPI number — MICHIGAN CANCER CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN CANCER CENTER 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:
1568548147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28455 HAGGERTY RD
Provider Second Line Business Mailing Address:
SUITE #203
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-324-4444
Provider Business Mailing Address Fax Number:
248-324-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28455 HAGGERTY RD
Provider Second Line Business Practice Location Address:
SUITE #203
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-324-4444
Provider Business Practice Location Address Fax Number:
248-324-2444
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EISENBERG
Authorized Official First Name:
LEOPOLDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-324-4444

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  4301033530 , 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)

  • Identifier: DC2359 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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