Provider Demographics
NPI:1750832705
Name:PETOSKEY RADIATION ONCOLOGY, PLC
Entity Type:Organization
Organization Name:PETOSKEY RADIATION ONCOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-4209
Mailing Address - Street 1:416 CONNABLE AVE
Mailing Address - Street 2:RADIOLOGY DEPT
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2212
Mailing Address - Country:US
Mailing Address - Phone:231-487-4209
Mailing Address - Fax:231-487-7840
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-4209
Practice Address - Fax:231-487-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty