Provider Demographics
NPI:1205126430
Name:PREMIER HEMATOLOGY ONCOLOGY CARE INC
Entity type:Organization
Organization Name:PREMIER HEMATOLOGY ONCOLOGY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-795-4060
Mailing Address - Street 1:8244 METRO PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2778
Mailing Address - Country:US
Mailing Address - Phone:586-795-4060
Mailing Address - Fax:
Practice Address - Street 1:8244 METRO PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2778
Practice Address - Country:US
Practice Address - Phone:586-795-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091736207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315035232OtherCONTROLLED SUBSTANCE
MI4301091736OtherLICENSE
MI1477569176Medicaid
MI5315035232OtherCONTROLLED SUBSTANCE