Provider Demographics
NPI:1225022288
Name:BARBARA ANN KARMANOS CANCER INSTITUTE
Entity Type:Organization
Organization Name:BARBARA ANN KARMANOS CANCER INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:248-827-4580
Mailing Address - Street 1:24601 NORTHWESTERN HWY
Mailing Address - Street 2:ATTENTION DIANE BAROKY
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2473
Mailing Address - Country:US
Mailing Address - Phone:248-827-4580
Mailing Address - Fax:248-827-7663
Practice Address - Street 1:4100 JOHN R ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1312
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:248-827-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID
MI0H26192Medicare ID - Type UnspecifiedGROUP