Provider Demographics
NPI:1780674093
Name:OSTEOPATHIC MEDICAL ONCOLOGY & HEMATOLOGY P.C.
Entity Type:Organization
Organization Name:OSTEOPATHIC MEDICAL ONCOLOGY & HEMATOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-710-0900
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-710-0900
Mailing Address - Fax:586-710-0915
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-710-0900
Practice Address - Fax:586-710-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM18910Medicare ID - Type Unspecified