Provider Demographics
NPI:1528018389
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:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENSCHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-977-4857
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:616-954-9800
Mailing Address - Fax:616-954-0659
Practice Address - Street 1:5800 FOREMOST DR SE STE 300
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:616-954-9800
Practice Address - Fax:616-954-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M08620OtherMEDICARE GROUP NUMBER