Provider Demographics
NPI:1184642555
Name:NORTH EASTERN MICHIGAN CANCER CENTER
Entity Type:Organization
Organization Name:NORTH EASTERN MICHIGAN CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-936-4302
Mailing Address - Street 1:3621 S. STATE ST.
Mailing Address - Street 2:700 KMS, RM 519, RAD ONC
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5170
Mailing Address - Fax:734-615-5851
Practice Address - Street 1:1501 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-356-7353
Practice Address - Fax:989-356-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI320Z41016OtherBLUE CROSS BLUE SHIELD
MI320Z41016OtherBLUE CROSS BLUE SHIELD