Provider Demographics
NPI:1609836428
Name:HEMATOLOGY-ONCOLOGY CENTER OF MICHIGAN
Entity Type:Organization
Organization Name:HEMATOLOGY-ONCOLOGY CENTER OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH-REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MDFACP
Authorized Official - Phone:248-557-1160
Mailing Address - Street 1:23832 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-8017
Mailing Address - Country:US
Mailing Address - Phone:248-557-1160
Mailing Address - Fax:248-552-8289
Practice Address - Street 1:23832 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-8017
Practice Address - Country:US
Practice Address - Phone:248-557-1160
Practice Address - Fax:248-552-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RH0003X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6047846Medicaid
MI4301067586OtherDR. RAJENDRA MANAN
MI4501184Medicaid
MI4301034420OtherDR. ILA SHAH-REDDY
MI4301034420OtherDR. ILA SHAH-REDDY
MIH11319Medicare UPIN
MION70690001Medicare ID - Type UnspecifiedDR. ILA SHAH-REDDY
MI6047846Medicaid
MI4501184Medicaid