Provider Demographics
NPI:1154082535
Name:BARBARA ANN KARMANOS CANCER HOSPITAL
Entity Type:Organization
Organization Name:BARBARA ANN KARMANOS CANCER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-576-8935
Mailing Address - Street 1:711 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1128
Mailing Address - Country:US
Mailing Address - Phone:248-951-6803
Mailing Address - Fax:248-951-6850
Practice Address - Street 1:711 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1128
Practice Address - Country:US
Practice Address - Phone:248-951-6803
Practice Address - Fax:248-951-6850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARBARA ANN KARMANOS CANCER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639661077Medicaid