Provider Demographics
NPI:1396833687
Name:CENTER FOR HEMATOLOGY-ONCOLOGY OF S. MICHIGAN
Entity Type:Organization
Organization Name:CENTER FOR HEMATOLOGY-ONCOLOGY OF S. MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AXELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-789-7122
Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1847
Mailing Address - Country:US
Mailing Address - Phone:517-789-7122
Mailing Address - Fax:517-789-5229
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1847
Practice Address - Country:US
Practice Address - Phone:517-789-7122
Practice Address - Fax:517-789-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N81810Medicare PIN