Provider Demographics
NPI:1467031013
Name:CANCER GENOMIC CONSULTANTS PC
Entity Type:Organization
Organization Name:CANCER GENOMIC CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-765-4282
Mailing Address - Street 1:1150 HEATHERLEA CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6238
Mailing Address - Country:US
Mailing Address - Phone:734-765-4282
Mailing Address - Fax:
Practice Address - Street 1:1150 HEATHERLEA CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-6238
Practice Address - Country:US
Practice Address - Phone:734-765-4282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty