Provider Demographics
NPI:1922075472
Name:COMPREHENSIVE HEMATOLOGY ONCOLOGY PHYSICIANS. P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE HEMATOLOGY ONCOLOGY PHYSICIANS. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-271-9010
Mailing Address - Street 1:4900 MERCURY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2947
Mailing Address - Country:US
Mailing Address - Phone:313-271-9010
Mailing Address - Fax:
Practice Address - Street 1:4900 MERCURY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2947
Practice Address - Country:US
Practice Address - Phone:313-271-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26443Medicare ID - Type Unspecified