Provider Demographics
NPI:1962449116
Name:WEST MI. REGIONAL CANCER AND BLOOD CENTER
Entity Type:Organization
Organization Name:WEST MI. REGIONAL CANCER AND BLOOD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:SOLIMAN
Authorized Official - Last Name:BEHAIRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-757-1260
Mailing Address - Street 1:6050 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:FREE SOIL
Mailing Address - State:MI
Mailing Address - Zip Code:49411-9157
Mailing Address - Country:US
Mailing Address - Phone:231-757-1260
Mailing Address - Fax:231-757-1261
Practice Address - Street 1:6050 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:FREE SOIL
Practice Address - State:MI
Practice Address - Zip Code:49411-9157
Practice Address - Country:US
Practice Address - Phone:231-757-1260
Practice Address - Fax:231-757-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P20480Medicare PIN