Provider Demographics
NPI:1114028982
Name:NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN HEMATOLOGY AND ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-487-4000
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 185
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-3478
Mailing Address - Fax:231-487-3578
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 185
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-3478
Practice Address - Fax:231-487-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION56640Medicare ID - Type Unspecified