Provider Demographics
NPI:1568548147
Name:MICHIGAN CANCER CENTER PC
Entity Type:Organization
Organization Name:MICHIGAN CANCER CENTER PC
Other - Org Name:DNS HEMATOLOGY ONCOLOGY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-324-4444
Mailing Address - Street 1:28455 HAGGERTY RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-324-4444
Mailing Address - Fax:248-324-2444
Practice Address - Street 1:28455 HAGGERTY RD
Practice Address - Street 2:SUITE #203
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-324-4444
Practice Address - Fax:248-324-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033530207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2359OtherMEDICARE RAILROAD
DC2359OtherMEDICARE RAILROAD