Provider Demographics
NPI:1508051533
Name:ASSOCIATES IN RADIATION ONCOLOGY, PC
Entity Type:Organization
Organization Name:ASSOCIATES IN RADIATION ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:MAURICIO
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-593-5852
Mailing Address - Street 1:1997 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1242
Mailing Address - Country:US
Mailing Address - Phone:313-436-2208
Mailing Address - Fax:313-436-2820
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:RADIATION ONCOLOGY DEPARTMENT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-5852
Practice Address - Fax:313-436-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICG4874OtherMEDICARE RAILROAD
MI0H21715OtherBLUE CARE NETWORK
MI0H21715OtherBLUE CARE NETWORK