Provider Demographics
NPI:1740275387
Name:BARBARA ANN KARMANOS CANCER INSTITUTE
Entity type:Organization
Organization Name:BARBARA ANN KARMANOS CANCER INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-576-8664
Mailing Address - Street 1:4100 JOHN R ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2013
Mailing Address - Country:US
Mailing Address - Phone:180-052-7626
Mailing Address - Fax:
Practice Address - Street 1:24601 NORTHWESTERN HWY
Practice Address - Street 2:BILLING DEPT.
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2473
Practice Address - Country:US
Practice Address - Phone:248-827-4580
Practice Address - Fax:248-827-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI833501251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08727OtherBLUE CROSS BLUE SHIELD MI
MI2680863Medicaid
MI2680863Medicaid