Provider Demographics
NPI:1114962644
Name:JEFFREY P. LETZER, DO, PLC. DBA KALAMAZOO HEMATOLOGY & ONCOLOGY
Entity Type:Organization
Organization Name:JEFFREY P. LETZER, DO, PLC. DBA KALAMAZOO HEMATOLOGY & ONCOLOGY
Other - Org Name:KALAMAZOO HEMATOLOGY & ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LETZER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-341-9200
Mailing Address - Street 1:1634 GULL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048
Mailing Address - Country:US
Mailing Address - Phone:269-341-9200
Mailing Address - Fax:269-341-4197
Practice Address - Street 1:1634 GULL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-341-9200
Practice Address - Fax:269-341-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
MIJL010182207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01008954OtherHEALTHPLUS OF MICHIGAN
MI053OtherCARE SOURCE MEDICAID HMO
MI0N89040OtherMEDICARE PLUS BLUE MICHIGAN
MI110C912010OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4290016Medicaid
MI4290016Medicaid
MI110C912010OtherBLUE CROSS BLUE SHIELD OF MICHIGAN