Provider Demographics
NPI:1013034669
Name:CANCER CARE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CANCER CARE ASSOCIATES, P.C.
Other - Org Name:WELLPOINTE LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:D'ERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-997-9000
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-852-4231
Mailing Address - Fax:248-852-4546
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:SUITE 107
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-852-4231
Practice Address - Fax:248-852-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4779624Medicaid
MI4779624Medicaid