Provider Demographics
NPI:1972529436
Name:RADIATION ONCOLOGY SPECIALISTS PC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMR
Authorized Official - Middle Name:M
Authorized Official - Last Name:AREF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-647-3100
Mailing Address - Street 1:19229 MACK AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-647-3100
Mailing Address - Fax:313-647-3111
Practice Address - Street 1:19229 MACK AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-647-3100
Practice Address - Fax:313-647-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M90750Medicare PIN