Provider Demographics
NPI:1609814631
Name:MACOMB HEMATOLOGY ONCOLOGY
Entity Type:Organization
Organization Name:MACOMB HEMATOLOGY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EFSTATHIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPAZOGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-558-4700
Mailing Address - Street 1:1122 BALFOUR ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1327
Mailing Address - Country:US
Mailing Address - Phone:586-558-4700
Mailing Address - Fax:586-558-4706
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-558-4700
Practice Address - Fax:586-558-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIET040673207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102880283Medicaid
MI0N71770Medicare ID - Type UnspecifiedMEDICARE GROUP ID
MI102880283Medicaid