Provider Demographics
NPI:1467017434
Name:CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Entity Type:Organization
Organization Name:CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Other - Org Name:RHEUMATOLOGY CENTERS OF WESTERN MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:REXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-850-0888
Mailing Address - Street 1:5800 FOREMOST DR SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7062
Mailing Address - Country:US
Mailing Address - Phone:833-850-0888
Mailing Address - Fax:
Practice Address - Street 1:5800 FOREMOST DR SE STE 202
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7062
Practice Address - Country:US
Practice Address - Phone:616-389-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANCER & HEMATOLOGY CENTERS OF WESTERN MI, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-06
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty